Objective: To assess the clinical value of X-ray-assisted endoscopic stent placement and laparoscopic resection in treatment of obstructive colorectal cancer. Methods: Seventy-five eligible patients with cancer in the descending colon or rectum presenting with obstruction during January 2007 to December 2013 were selected. Of the patients, 37 cases underwent X-ray- assisted endoscopic stent placement and laparoscopic resection (combination group), and 38 cases were subjected to open resection plus intraoperative colonic lavage (conventional group). The main clinical variables between the two groups were compared. Results: The preoperative data between the two groups of patients were comparable. In combination group, the success rate of stent placement via colonoscopic procedure was 89.19% (33/37) and success rate of laparoscopic operation was 3.94% (31/33), and the 6 cases with operative failure were excluded. Compared with conventional group, except for increased cost of treatment (30 600 yuan vs. 25 500 yuan), the combination group showed significant advantages in intraoperative polyp detection rate (35.48% vs. 7.89%), radical resection rate (83.9% vs. 71.1%), rate of intraoperative preventive terminal ileostomy (6.45% vs. 23.68%), operative time (175.45 min vs. 202.24 min), length of incision (4.88 cm vs. 16.84 cm), number of resected lymph nodes (16.80 vs. 11.92), incidence of overall complications and infection-related complications (16.13% vs. 39.47%; 6.45% vs. 26.32%), length of postoperative hospital stay (7.36 d vs. 11.05 d), rate of second-stage surgery (6.5% vs. 28.9%), and positive rate of polyps at 3 months postoperatively (all P<0.05). There was no statistical difference in 1-, 3- and 5-year survival rate between the two groups (all P>0.05). Conclusion: X-ray-assisted colonoscopy combined with laparoscopic resection for obstructive colorectal cancer is safe and feasible, and it also has ideal radical effects and can reduce the rate of second-stage surgery.