Comparative effectiveness of colonic stenting alone and with neoadjuvant chemotherapy for patients with left-sided obstructive colon cancer: a meta-analysis

Background: The effective management of acute left-sided obstructive colon cancer (LSOCC) remains challenging. This meta-analysis compared the short-term and long-term outcomes between two prevalent treatment approaches: selective surgery following colonic stenting (CS) and colonic stenting combined with neoadjuvant chemotherapy (CS-NAC). Methods: We conducted a comprehensive literature search of databases, including PubMed and Web of Science, covering the period from January 2000 to May 2025. Relevant studies comparing CS with CS-NAC were identified and analyzed. Both the short-term and long-term outcomes of the two treatment strategies were evaluated. The meta-analysis calculated pooled odds ratios (ORs), mean differences (MDs), and 95% confidence intervals (95% CIs). This study is registered with PROSPERO (registration number: CRD42024580176). Results: Seven studies were included in the meta-analysis. Compared with the CS strategy, the CS-NAC strategy demonstrated significantly better short-term outcomes, including higher rates of laparoscopic surgery, lower intraoperative stoma rates, fewer overall postoperative adverse events, shorter operative times, and shorter postoperative hospital stays. However, no significant differences were observed between the two strategies in terms of stent-related complications or specific short-term adverse events, including postoperative incision infection rates, anastomotic leakage rates, and pulmonary infection rates. Furthermore, compared with the CS strategy, the CS-NAC strategy significantly improved both 3-year disease-free survival and overall survival. Conclusion: Compared with CS alone, the CS-NAC treatment strategy improves laparoscopic surgery rates and 3-year survival outcomes without increasing the risk of certain postoperative adverse events.