Aim — to standardize surgical care for malignant colonic obstruction. Material and methods. There were 572 patients with malignant colonic obstruction: 247 of them were hospitalized in 2011—2013 (I group); 325 — in 2014—2017 (group II). Forty-six patients underwent medication; 302 — acute resection; 141 — stoma construction; 83 — stent deployment. Elective surgery and radiation or chemotherapy was performed after 0.5—6 months in 110 patients of group II. Acute resection was more common in I group, elective resection — in group II. Early and long-term results including Kaplan—Meier 3-year overall survival were compared in both groups. Results. Complications occurred in 46.69% (group I) and 21% (group II). Postoperative mortality was significantly higher in group I compared with II group: 26.11 and 10.33%, respectively. Three-year overall survival was higher in group I compared with group II: 0.82 and 0.69, respectively. Conclusion. Advisability of new two-stage surgical standard is confirmed for malignant colonic obstruction. Stoma formation and stenting may be a valid alternative in some patients with malignant colonic obstruction due to significantly lower postoperative mortality.