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Elderly patients with colon cancer are often diagnosed with large-bowel obstruction, being their physical condition usually compromised because of significant weight loss in context of a preceded period of absent defecation with poor oral intake.
Nonelective surgery in the treatment for obstructive colon cancer is associated with increased postoperative morbidity, higher anastomotic leakage rates, worse oncological outcome, and increased mortality. Initial decompression of the colon in frail patients with left-sided malignant colonic obstruction is recommended as a bridge to elective surgery that enables their optimization and staging. Self-expandable metal stent (SEMS) placement is in discussion due to oncologic concerns. Decompressing stoma (DS) is proposed as a valid alternative, but there is a lack of evidence comparing both techniques.
Hartmann’s procedure remains one of the most common procedures in emergency surgery of the left colon, available for patients with high risk of anastomotic leakage or who are unstable. Resection and Primary Anastomosis will be an option for uncomplicated malignant left-sided large bowel obstruction in absence of other risk factors that may lead to an anastomotic leakage, preferably performed by a colorectal surgeon.
