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BACKGROUND: In recent years, with population aging, there has been an increased number of colorectal cancer cases with
severe occlusion symptoms. About 75% of obstructions due to malignant colorectal cancer (10-30%) occur distal to splenic flexure.
METHODS: The authors evaluated the best surgical therapeutic strategy to be used in cases of left-sided colorectal carcinoma in patients over 65 years old, especially considering the emergency condition, age of patients and efficacy in terms of postoperative morbidity, mortality and 5 years survival rate.
RESULTS: The management of left-sided obstructing colorectal carcinoma is controversial. Hartmann’s procedure is the
best therapeutic choice in elderly patients. However, resection with intraoperative colonic wash-out and primary anastomosis has favorable outcome in low risk patients.
CONCLUSIONS: A review of the literature reveals that primary resection and anastomosis for left-sided obstructing CRC
is the correct therapeutic strategy in low risk patients with localized, resectable carcinoma, without peritonitis; Hartmann’s procedure should be adopted in doubtful cases and in high risk patients.