Colorectal cancer frequently presents with obstruction or perforation at the time of diagnosis, and requires urgent surgery. Various surgical and endoscopic approaches are available that minimize the risk of complications related to emergency colorectal operations and optimize the oncological outcome for the patients. The surgeon has to make clinically and oncologically adequate decisions, ranging from diverting colostomy to partial or total colectomy in a one-stage procedure or multistage interventions. The endoscopic insertion of a self-expanding metallic stent is an option either as a definitive procedure in palliative conditions or as a bridge to safer elective surgery. In this article, we discuss the current surgical and endoscopic treatments of complicated colorectal cancer and propose an algorithm for the management of patients with obstructive tumors.