Purpose Malignant large bowel obstruction (MLBO) is a common emergency presentation of colorectal cancer. Management options include emergency tumour resection or endoscopic colonic stenting, often used as a bridge to surgery. The optimal approach remains controversial. This study aimed to compare short-term outcomes between colonic stenting and tumour resection for MLBO at a large Australian tertiary centre. Methodology A retrospective cohort study was conducted of adult patients presenting with left-sided MLBO between 2009 and 2025. Patients were identified using procedural coding and grouped according to primary intervention: colonic stent insertion or tumour resection with or without anastomosis. Demographic, clinical, operative, and outcome data were extracted from institutional databases. Variables were compared using Chi-square or Fisher’s exact tests. Statistical significance was set at p<0.05. Results Preliminary analysis included 95 patients: 77 underwent tumour resection and 18 underwent colonic stenting. Baseline ASA grade differed significantly between groups (p=0.047), with higher-risk patients more commonly managed with stenting. There was no significant difference in post-operative ileus (p=1.000) and unplanned return to theatre (p=0.580). Mortality (p=0.040) and length of stay (p=0.029) was higher in the stent group. Conclusion In this preliminary cohort, colonic stenting for MLBO was associated with higher observed mortality compared to tumour resection, likely influenced by baseline patient risk rather than treatment effect alone. Short-term complication rates were otherwise comparable. Ongoing data collection and risk-adjusted analyses are required to better define optimal management strategies.