Objective To compare the outcomes after self-expanding metallic stent (SEMS) or transanal drainage tube (TDT) placement in patients with malignant large-bowel obstruction (MLBO).Methods Seventy-three patients with MLBO from the clinical unit underwent SEMS (n =51) or TDT (n =22) placement from 2012 to 2017.The success rates of placement,clinical outcomes after decompression,complications,the time to resuming enteral nutrition (EN),Kofsky performance status (KPS) scoring and the following-up therapeutic options were investigated.Results Technical success were achieved in 100％ of patients in both groups.The clinical success rates were 98.0％ (50/51) for SEMS and 95.5％ (21/22) for TDT.No perforation was found in any group,while 3.9％ (2/51) in the SEMS and 18.2％ (4/22) in TDT group experienced displacement (P =0.26).It took 2.1 IQR (0-2) days and 3 IQR (2～5) days to resume EN in the SEMS and TDT groups,respectively (P ＜ 0.001).The KPS scores were significantly higher in patients implanted with SEMS (70,IQR 50～80) than in those with TDT (35,IQR 30～50) (P ＜ 0.001).In the SEMS group,37.3％ (19/51) of patients underwent stenting as a bridge to surgery,9.8％ (5/51) for chemotherapy only and 52.9％ (27/51) for palliation,while 40.9％ (9/22),0 and 59.1％ (13/22) underwent placement for these reasons in the TDT group,respectively.The majority (6/9) of the patients who underwent TDT placement as a bridge to surgery required stoma creation,while only 31.6％ (6/19) of those in the SEMS group needed a stoma (P =0.080).In addition,anastomotie leakage was only found in the TDT group (2/9) (P =0.10).Conclusion Both SEMS and TDT placement could provide clinical relief for MLBO.However,SEMS placement is associated with earlier EN,fewer complications,and benefits for the postoperative quality-of-life.