Objective To compare the outcomes after SEMS or TDT placement in patients with malignant large-bowel obstruction (MLBO). Methods 48 patients with MLBO from the clinical unit accepted SEMS (n=26) or TDT (n=22) placement from 2012 to 2016 were collected. The outcomes evaluation, successful rates of placement, clinical outcomes after decompression, complications, the timing of resuming to EN, Karnofsky Performance Status (KPS) scoring and the following-up therapeutic options were included. Results Technical success were achieved in 100% patients in both groups. Clinical success rates were 96.2% (25/26) for SEMS and 95.5% (21/22) for TDT. There was no perforation found in any group, while 7.7% (2/26) in SEMS and 18.2% (4/22) in TDT group experiencing a complication of displacement (P=0.26). 2 IQR(0~2) days and 3 IQR(2~5) days should be taken to resume to EN in each group, respectively (P=0.001). KPS scores were significantly higher in patients with SEMS (75 IQR50~80) than in those with TDT (35 IQR30~50) (P=0.001). There were 30.8% (8/26) patients undergoing stenting as bridge to surgery, 7.7% (2/26) patients for chemotherapy only and 61.5% (16/26) for palliation and nutritional therapy in SEMS group, while 31.8% (7/22), 0 and 59.1% (13/22) in TDT group, respectively (P=0.36). The patients requiring stoma creation were 57.1% (4/7) in TDT group and 25.0% (2/8) in SEMS group, respectively, while postoperative anastomotic leakage was found only in TDT group (1/7). Conclusions Both SEMS and TDT placement could achieve a clinical relief for MLBO effectively. However, SEMS placement is associated with earlier EN and is more obvious postoperative quality-of-life benefits in MLBO.