Nationwide Analysis of Right-Sided Colonic Stenting: Rarely Used but Reduces Stoma Creation Significantly

BACKGROUND AND AIMS: Right-sided malignant colonic obstruction frequently requires emergent intervention and is associated with high perioperative morbidity and mortality. Self-expanding metallic stents (SEMSs) have been extensively studied in left-sided disease, but their role in right-sided obstruction remains poorly defined. Our aim was to evaluate nationwide trends, patient characteristics, and outcomes associated with SEMS use in right-sided malignant colonic obstruction. METHODS: Using the Nationwide Readmissions Database (2016-2022), we identified patients with right-sided malignant colonic obstruction. Patients were stratified by SEMS placement. Weighted univariate and multivariable logistic regression analyses were used to compare demographics, hospital characteristics, and 90-day postoperative outcomes. RESULTS: Among 24,146 patients, only 251 (1.0%) underwent SEMS placement. SEMS-treated patients were more likely to be in-state residents (95.0% vs 89.6%), from large metropolitan areas (70.5% vs 53.4%), and from higher-income quartiles (31.0% vs 22.3%; all P < 0.01). SEMS placement was associated with significantly lower stoma rates (<4.0% vs 9.1%; P < 0.01) and higher rates of deep vein thrombosis (8.0% vs 3.8%; P < 0.01). Multivariable analysis showed that SEMS reduced need for stoma (adjusted odds ratio, 0.19; 95% CI, 0.07-0.50), while metastatic disease increased stoma risk (adjusted odds ratio, 2.36; 95% CI, 2.12-2.63). CONCLUSIONS: SEMS use in right-sided malignant obstruction was associated with a significantly lower need for stoma formation and comparable short-term outcomes. Despite potential benefits, utilization remains low. Further prospective studies are warranted to better define patient selection criteria and long-term oncologic outcomes.