Based on data obtained in a prospective, multicenter trial investigating the surgical treatment of colorectal carcinomas, the aim of this study was to investigate the value and relevance of Hartmann's procedure compared with alternative surgical approaches in elective interventions and emergency situations in carcinoma of the rectum (n=10,355) and the left hemicolon (n=8,825). Only in 3.4% (n=353) of patients with rectal carcinoma was the Hartmann's procedure executed with curative intention, indicating that this approach is recommendable only in (1) rare emergency situations (1.66%, n=172), (2) selected cases with elective intervention such as high-risk patients or subjects with poor prognosis, and (3) individuals with rectal carcinoma of the lower third who require deep resection (2+3, 1.75%, n=181). However, Hartmann's procedure resulted in the lowest mortality (7.5%) of the various procedures aiming for radical resection in the case of luminal obstruction or perforation at the left hemicolon. With palliative intention, 4.3% of patients with rectal carcinoma (n=449) received primary colostomies. At the left hemicolon, palliative segmental colon resection with primary anastomosis maintaining intestinal passage showed the lowest mortality (6.1%) and perioperative morbidity (33.9%) under elective circumstances, whereas Hartmann's procedure was preferred in emergency situations.