Abstract
BackgroundUp to 15% of colorectal cancer (CRC) patients present with obstructive or perforated tumours, and require emergency surgery. The Hartmann's procedure (HP) provides the opportunity to achieve a potentially curative (R0) resection, while minimizing surgical trauma in poor-risk patients. The aim of this study was to assess the surgical (operative mortality), and oncological (long-term survival after curative resection) results of emergency HP for obstructive or perforated left-sided CRC.MethodsA retrospective review of 50 patients who underwent emergency HP for perforated/obstructive CRC in our institution between 1995 and 2006.ResultsMedian age of patients was 75 (range 22–95) years and the indications for HP were obstruction (32) and perforation (18 patients). Operative mortality and morbidity were 8% and 26% respectively. 35 patients (70%) were operated with a curative intent; in this group, overall 1-, 3- and 5-year survival rates were 80%, 54% and 40%. In univariate analysis, the presence of lymph node metastases was associated with poor 5-year survival (62% [Stage II] vs. 27% [Stage III], log-rank test, p = 0.02). Eleven patients (22%) had their operation reversed with a median delay of 225 (range 94–390) days. In this subgroup, two patients died from distant metastases, but there were no instances of loco-regional recurrence.ConclusionHartmann's operation remains a good option to palliate symptoms in 30% of patients with left-sided CRC who are not candidates to a curative resection. For those who have a curative resection, the oncological outcome is acceptable, especially stage II patients, who appear to benefit the most from this surgical strategy.
Highlights
Up to 15% of colorectal cancer (CRC) patients present with obstructive or perforated tumors and require emergency surgery
This procedure gained wide acceptance in the 1970s for the management of complicated diverticulitis, and it is surprising that few series have focused on CRC patients, and addressed the oncological outcome of this procedure
McArdle and Hole have demonstrated that emergency surgery for CRC is associated with high (8%) mortality and poor (39%) 5-year overall survival rates, even after a curative resection [8]
Summary
Up to 15% of colorectal cancer (CRC) patients present with obstructive or perforated tumours, and require emergency surgery. Up to 15% of colorectal cancer (CRC) patients present with obstructive or perforated tumors and require emergency surgery In this setting, colonic resections carry 10– 20% mortality and 30–50 morbidity rates, due to the patients' poor condition [1,2]. Colonic resections carry 10– 20% mortality and 30–50 morbidity rates, due to the patients' poor condition [1,2] These patients would benefit from preoperative insertion of a metallic stent, in order to eventually perform a semi-elective curative resection with primary anastomosis [3]. It would be tempting to consider that emergency HP for left-sided CRC is an obsolete operation, often performed with a palliative intent in elderly and/or very sick patients with a high risk of cancer-related as well as intercurrent death [9]
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