Colonic stenting has been performed around the world for left-sided malignant colonic obstruction both as bridge to surgery and for palliative intent [1,2]. It represents an effective, minimally invasive way to relieve malignant obstruction. According to international guidelines, stenting has been offered as first-line treatment to relieve obstruction in patients with metastatic disease since 2014 [3]. However, it's role as a bridge to curative surgery is still debatable. Previous randomized controlled trials have been terminated due to high complication rate from stenting. These complications could lead to poor oncological outcome [1,2,4]. Also, there has been studies indicating probable inferior oncological outcome in patients who underwent colonic stenting as bridge to curative surgery compared to emergency surgery [5]. However meta-analysis on randomized controlled trials and retrospective reviews found no differences in 3 years disease free or overall survival. Latest international guidelines suggest stenting as a bridge for curative surgery in centres with expertise in stenting [6].

The optimal timing for definitive surgery after stenting as bridge to surgery has not been well established. Up to date, multiple randomized controlled trials have been performed for stent as bridge to surgery as emergency treatment of obstructive colonic tumours. However, the timing to definitive surgery is variable in various trials [1,4]. Further study is necessary as the patient outcome may be different if the timing to definitive surgery is different.

In real-life clinical settings, there may be a wide variation in the time taken from stent to definitive surgery for different patients. After successful stenting for malignant intestinal obstruction, the time needed for recovery for each patient may differ. Often the complete staging of their cancer is carried out after the patients have recovered from their intestinal obstruction. The patients would then proceed to a multidiscipline team evaluation on the best treatment modality and would be referred for anesthetist assessment if recommended for surgery. Additional time may be required to optimize their medical co-morbidities after an episode of acute intestinal obstruction. Operation theatre space may not be immediately available due to resource limitations. Therefore, it may take around 4 weeks after successful stenting for assessment and optimization before definitive surgery.

In such context, this study aimed to review the 10-year result of our centre on colonic stenting to determine whether colonic stenting as a bridge to surgery is feasible and safe in terms of acceptable short-term and long-term outcomes. This is of fundamental importance to judge whether patients with left-sided malignant intestinal obstruction should offered an emergency surgery or a stent as a bridge to surgery. Also, we would like to determine the optimal timing of definitive surgery after colonic stenting and to see if it is oncologically safe to defer definitive surgery for 4 weeks to optimize patient's condition before surgery.