Colostomy for acute tumoral large intestine obstruction in an on-call surgical hospital: clinical recommendations and real-world clinical practice

Objective. To analyze the immediate and long-term results of colostomy in patients with acute tumor intestinal obstruction. Materials and methods. The study includes the results of examination and treatment of 552 patients with the diagnosis of acute malignant intestinal obstruction and tumor localization in the descending colon and sigmoid colon, who were hospitalized in on-duty surgical wards in the Samara region from 2015 to 2020. The study is of a non–randomized multicenter retrospective continuous sequential controlled type. Two groups of patients were identified from the general group of patients with colostomy. Upon discharge, the patient was referred for further examination and treatment to a regional oncology center. Results. It is necessary to change the principles of the organization of oncological care in terms of reducing the time of preoperative examination, timely diagnostic evaluation at the initial visit to the oncology center. On the other hand, a possible solution to this problem may be primary resection based on the oncological principle with a single-barrel colostomy formation in an urgent surgical hospital. This will allow the patient to get a time reserve and reduce the frequency of complications related to the intestinal stoma even in case of a delay in admission to the oncological center. Conclusions. Decompressive proximal colostomy remains the leading intervention aimed at resolving intestinal obstruction in patients with tumors of the descending colon and sigmoid colon, even in the patient's operability. The delay in hospitalization for a specialized stage of oncological care is associated with both medical and organizational aspects, and social and domestic factors of a non-medical nature, and affects the subsequent outcome of a radical surgery.