# Management of right-sided obstructing colon cancers: scoping review

## TL;DR

This review explores alternative approaches to emergency surgery for right-sided colon cancer, suggesting they may reduce complications but lacks strong evidence.

## Contribution

A comprehensive scoping review of recent literature on managing right-sided obstructing colon cancers with a focus on bridge-to-surgery approaches.

## Key findings

- Emergency resection is the most common treatment for ROCCs.
- Bridge-to-surgery approaches like stents or stomas show potential to reduce complications.
- Current evidence is limited by non-randomized and retrospective study designs.

## Abstract

Patients presenting with right-sided obstructing colon cancers (ROCCs) typically undergo emergency surgical resection. Emerging evidence suggests using a bridge-to-surgery (BTS) approach with a stoma or stent reduces mortality and perioperative morbidity while not effecting long-term survival. The aim of this scoping review was to provide a comprehensive report of the recent literature reporting the management of ROCC.

Systematic searches were conducted of the Embase, MEDLINE, and CENTRAL databases for studies published between 2000 and 2025. Searches were uploaded to the Covidence review tool and dual screened (abstract and full text) against prespecified inclusion criteria. Key data extraction points were: study characteristics, interventions used, patient and oncological descriptors, and outcomes reported. Data are reported descriptively as per PRISMA-ScR guidance.

Twenty-seven studies were identified: 22 primary research studies and 5 systematic reviews. Primary research studies were predominantly retrospective cohorts (20), with nine single-centre studies. Emergency resection was the most common intervention (7528, 75.4%), ahead of a colonic stent as a BTS (2289, 22.9%) and defunctioning stoma as a BTS (114, 1.1%). Of note, the vast majority of patients treated with a stent were from a single paper. There were 76 different descriptors reported, with 61 reported in fewer than five studies. In all, 70 perioperative, 8 stent-specific, and 21 oncological outcomes were reported. The focus was on perioperative outcomes, with only two oncological outcomes reported in five or more studies. Of the five included systematic reviews, four compared emergency resection to BTS and reported favourable outcomes of the BTS approach.

Current available evidence is non-randomized and limited by retrospective study design. Although BTS appears favourable, studies are poorly powered, meaning the current evidence is insufficient to support BTS approaches.

Right-sided obstructing colon cancers are usually managed with emergency resection, which comes with high morbidity, limiting access to adjuvant chemotherapy. This study provides an up-to-date review of the current literature supporting alternative approaches via the bridge-to-surgery approach. These approaches appear favourable, but data are lacking to support these conclusions.