Outcomes of colostomy versus primary anastomosis in left‐sided obstructive colon cancer

Abstract Objective Left‐sided colonic obstruction due to malignancy is a life‐threatening surgical emergency. End colostomy after resection has traditionally been preferred because of concerns regarding anastomotic leakage. However, primary anastomosis is increasingly reported as a feasible alternative in selected cases. This study compared postoperative outcomes of end colostomy and primary anastomosis in the management of left‐sided obstructive colon cancer. Methodology This retrospective observational study included patients who underwent emergency surgical resection with end colostomy or primary anastomosis for obstructive left‐sided colonic adenocarcinoma from 2012 to 2024. Postoperative complications, oncological outcomes and timing of adjuvant therapy were compared between groups. Results Seventy‐one patients were included in the study (end colostomy, n = 47; primary anastomosis, n = 24). Patients undergoing colostomy were older ( p = .01) and had higher ASA scores ( p = .04). Overall postoperative complication rates were higher in the colostomy group (36.2% vs. 16.7%), although the difference was not statistically significant ( p = .08). Administration of adjuvant therapy and time to initiation were similar between groups. Conclusions End colostomy remains a valid option for high‐risk patients, particularly those of advanced age or with significant comorbidities. Primary anastomosis demonstrated comparable short‐term safety, with similar complication rates. Careful patient selection and individualized surgical planning are essential to optimize outcomes.