Objective:This retrospective study aims to compare the performance for managing acute left colonic malignant obstruction by emergency surgery(ES) or stenting as a bridge to surgery(BTS). Methods:The medical records were collected from May 2013 to December 2017 in two tertiary hospitals in Eastern China. Clinical success was defined as resumption of intestinal function for 30 days without morbidity or mortality after surgical procedure. All demographics,intervention procedures and follow-up were analyzed for short-term and long-term outcomes. Risk factors for long-term survival were discussed as well. Results:BTS group showed better short-term performance,including less intraoperative decompressive intervention(85.1% vs. 69.6%,P=0.045),more complete decompression(64.2% vs. 27.5%,P<0.001),more primary anastomosis(65.7% vs. 17.4%,P<0.001),less temporary and permanent stoma(34.3% vs. 82.6%,13.4% vs. 58.7%,both P<0.001),less intensive care unit requirement(10.4% vs. 27.5%,P=0.011),less intraoperative complications(3.0% vs. 13.0%,P=0.031)and reduced 30-day mortality(0 vs. 8.7%,P=0.028). No significant difference was observed about clinical success(73.1% vs. 63.8%,P=0.240),overall mortality(53.7% vs. 64.4%,P=0.247)or long-term survival(52.0 months vs. 35.0 months,P=0.121). TNM stage Ⅳ,permanent stoma and postoperative complication were the independent risk factors for long-term survival. Conclusion:BTS is a safe and effective therapeutic option for acute left colonic malignant obstruction,without adverse effect on long-term survival. It significantly improves short-term outcomes by reducing perioperative complications,30-day mortality and permanent stoma. More prospective studies are necessary to confirm the clinical findings.