ObjectiveThe aim of this current meta-analysis is to evaluate the efficacy and safety of selective surgery after colonic stenting versus emergency surgery for acute obstructive colorectal cancer.MethodsThe studies published from January 1, 2000 to July 31, 2018 were searched from Pubmed, Embase, Cochrane Library, CNKI, Wanfang database, and VIP database. RevMan 5.3 software was used for data analysis.ResultsA total of 21 studies were included in this meta-analysis. Compared to emergency surgery, selective surgery after colonic stenting had significant lower mortality rate [OR=0.44, 95% CI was (0.26, 0.73), P<0.05], permanent stoma rate [OR=0.46, 95% CI was (0.23, 0.94), P<0.05], complication rate [OR=0.47, 95% CI was (0.35, 0.63), P<0.05], and wound infection rate [OR=0.40, 95% CI was (0.25, 0.65), P<0.05）], but had significant higher primary anastomosis rate [OR=3.30, 95% CI was (2.47, 4.41), P<0.05] and laparoscopic surgery rate [OR=12.55, 95% CI was (3.64, 43.25), P<0.05]. But there was no significant differences between the two groups as to anastomotic leak rate [OR=0.86, 95% CI was (0.48, 1.55), P>0.05].ConclusionsSelective surgery after colonic stenting can be identified in a reduced incidence of mortality rate, complication rate, permanent stoma rate, and wound infection rate, and also can increase primary anastomosis rate and laparoscopic surgery rate. Thus, for acute obstructive colorectal cancer, selective surgery after colonic stenting is better than emergency surgery.