Objective:To evaluate the clinical value and safety of colorectal stenting as a bridge to primary anastomosis placed endoscopically using fluoroscopic guidance versus emergency surgical decompression on acute resectable malignant colorectal obstruction. Methods:From May 2001 to October 2012,94 patients were diagnosed with acute colorectal malignant obstruction. Thirty patients underwent metal stent placement as a bridge to an elective resection and primary anastomosis,while 64 patients underwent emergency surgery. The two group were compared for successful one-stage operation,operation time,postoperative ventilation time,hospital stay,hospital mortality and postoperative complications. And the clinical and technical success rate of stent placement,the rate of stent-related complication and after stenting accept laparotomy and laparoscopic surgery in the stent group was analyzed. Results:There was a significant difference in successful one-stage operation and morbidity between two groups. A resection and anastomosis stent group was significantly higher than emergency surgery group (96.67% vs 53.13%,P < 0.001). The postoperative morbidity in stent group was significantly lower than that in emergency surgery group (6.67% vs 25.0%,P < 0.05). There was no statistically significant difference in mortality rate in both groups. In stent group,operative time,postoperative ventilation time was (156.13 ± 49.79) min,(3.60 ± 1.40) d,which were significantly lower than those of the emergency surgery group. The stent group had no significant difference on hospital stay compared with emergency surgery group(P > 0.05). The stent insertion was 100% successful in attempted stent placements. The clinical success rate was 96.67% in the stent group. The stent-related complication was 6.67%. The mean interval between stenting and surgery was(8.9 ± 1.0)d. Patients in the sent group underwent significantly more laparoscopic surgery than in emergeney surgery group(P < 0.01). Surgery time stent group undergoing laparotomy is shorter than the stent group undergoing laparoscopic surgery (P < 0.05),laparotomy complications was significantly lesser than the minimally invasive laparoscopic surgery in the sent group (P < 0.05),but received laparotomy patient＇s hospital stay was significantly longer than patients undergoing laparoscopic surgery. Conclusion:Colorectal stenting placed endoscopically using fluoroscopic guidance as a bridge to a primary surgical procedure is effective. Elective surgery after stenting is more safer than emergency surgery. Elective surgery could increase the chance of primary anastomosis,and reduce postoperative complications,and can be used as an effective treatment for remission of malignant colorectal obstruction. Laparotomy is still the main choice after stenting for elective surgery. By stent implantation,patients can get the opportunity of minimally invasive surgery.