Obstructive left side colon cancer: time for a tailored operative approach?

BACKGROUND Colorectal cancer (CRC) obstruction is frequent but doubts remain on the best treatment. The aim of this study is to analyze the different operative approach used for CRC treatment and evaluate the outcomes for the different cases. MATERIALS AND METHODS Patients were collected from January 2014 to December 2019 and divided in four groups (PH = Hartmann's procedure, PA = primary anastomosis - P groups - SD = deviating stoma, SS = SEMS - S groups). The main end-points were the quality of life and the oncologic safety. RESULTS 108 patients were enrolled. The mean follow-up time was 39 months. The stomas were performed less frequently in SS but lasted more in that group. Only 45% underwent reversal surgery. Cumulative operating time was greater in S vs P. The rate of major complications was similar. PA had a greater overall survival and disease-free survival than PH. CONCLUSIONS The various options of treatment should have different indications: primary anastomosis in stable patients, Hartmann in critical cases, SEMS for palliative intent and stoma when neo-adjuvant therapy is needed.