Abstract
PurposeTo describe the postoperative surgical complications in patients with rectal cancer undergoing Hartmann’s procedure (HP).MethodsData were retrieved from the Swedish Colorectal Cancer Registry for all patients with rectal cancer undergoing HP in 2007–2014. A retrospective analysis was performed using prospectively recorded data. Characteristics of patients and risk factors for intra-abdominal infection and re-laparotomy were analysed.ResultsOf 10,940 patients resected for rectal cancer, 1452 (13%) underwent HP (median age, 77 years). The American Society of Anesthesiologists (ASA) score was 3–4 in 43% of patients; 15% had distant metastases and 62% underwent a low HP. The intra-abdominal infection rate was 8% and re-laparotomy rate was 10%. Multivariable logistic regression analysis identified preoperative radiotherapy (OR, 1.78; 95% CI, 1.14–2.77), intra-operative bowel perforation (OR, 1.99; 95% CI, 1.08–3.67), T4 tumours (OR, 1.68; 95% CI 1.04–2.69) and female gender (OR, 1.73; 95% CI, 1.15–2.61) as risk factors for intra-abdominal infection. ASA score 3–4 (OR, 1.62; 95% CI, 1.12–2.34), elevated BMI (OR, 1.05; 95% CI, 1.02–1.09) and female gender (OR, 2.06; CI, 1.41–3.00) were risk factors for re-laparotomy after HP. The rate of intra-abdominal infection was not increased after a low HP.ConclusionsDespite older age and co-morbidities including more advanced cancer, patients undergoing Hartmann’s procedure had low rates of serious postoperative complications and re-laparotomy. A low HP was not associated with a higher rate of intra-abdominal infection. HP seems to be appropriate for old and frail patients with rectal cancer.
Highlights
Survival and local recurrence rates after rectal cancer have improved since the introduction of total mesorectal excision and preoperative radiotherapy (RT) [1, 2]
Of 10,940 patients resected for rectal cancer, 1452 (13%) underwent Hartmann’s procedure (HP)
In 62% of the patients, the distance of the tumour from the anal verge was 10 cm or less, which means that the rectum was transected just above the levator ani and corresponded to a low HP
Summary
Survival and local recurrence rates after rectal cancer have improved since the introduction of total mesorectal excision and preoperative radiotherapy (RT) [1, 2]. The number of patients with rectal cancer treated surgically with. Hartmann’s procedure (HP) is increasing, especially among old and frail patients with metastatic disease [3]. Postoperative complications have been reported after HP performed to treat diverticular disease and sigmoid cancer with transection of the proximal rectum [4, 5]. The morbidity after HP in patients with rectal cancer and distal transection of the rectum has been rarely reported. Some reports have shown a high frequency of postoperative complications such as pelvic abscesses—especially after low HP— and increased rates of re-operation and re-admission [6,7,8]. Most previous studies have been small, retrospective and not population based, and do not provide clear conclusions about which procedure is best suited for old and frail patients
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