Die Hartmann-Operation

Abstract

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.

Incurable Stenosing Colorectal Carcinoma: Endoscopic Stent Implantation or Palliative Surgery?

“…This makes a proper comparison difficult. Our results for palliative surgical intervention largely reflect those reported in the literature—for example, a mortality up to 30% and a morbidity of up to 50%;1–11 these figures are considerably higher than those reported for endoscopic procedures: 2% and 30%, respectively 1–3,12–14,16–18. Endoscopic interventions may be expected to cause only a low complication rate in the short‐term postinterventional course.…”

“…The only aim of this symptomatic treatment is the elimination of tumor‐associated symptoms, such as hemorrhage, obstruction, and/or perforation, which can result in an improvement or preservation of the patient’s quality of life but which also involves the associated disease‐specific and treatment‐related risks. With respect to palliative surgical interventions in colorectal carcinomas, data obtained from the literature indicate an intervention‐related morbidity and mortality of 5–15% and 0–30%, respectively, as well as a median survival of 4–17 months in UICC stage IV tumor lesions 1–11. In recent years, the implantation of self‐expanding metal stents (SEMS) has been established as an alternative therapeutic option—in particular in patients at high surgical risk or with locally unresectable colorectal carcinomas.…”

“…With respect to palliative surgical interventions in colorectal carcinomas, data obtained from the literature indicate an intervention-related morbidity and mortality of 5-15% and 0-30%, respectively, as well as a median survival of 4-17 months in UICC stage IV tumor lesions. [1][2][3][4][5][6][7][8][9][10][11] In recent years, the implantation of selfexpanding metal stents (SEMS) has been established as an alternative therapeutic option-in particular in patients at high surgical risk or with locally unresectable colorectal carcinomas. The reported intervention-related morbidity and mortality are appreciably lower than in palliative surgical interventions.…”

Der Notfalleingriff beim Kolonkarzinom

“…Jestin et al [15] In der Literatur werden Resektionsraten von 56 % bis 94 % berichtet [1,11,15,17,26,27,28,31,34], wobei in den letzten Jahren die Gesamtresektionsraten, die R0-Resektionsraten und die einzeitigen Resektionen zunahmen. Die Notfallsituation ist eine wichtige Indikation fü r die Hartmann-Operation und wird vor allem beim linksseitigen Kolonkarzinom angewandt [8]. Der Vorteil liegt insbesondere in der schnellen und sicheren Durchfü hrung der Operation, der Nachteil im Verlust der Kontinenz, bzw.…”

Predictors of Long-Term Outcomes of Video-Laparoscopic Versus Open Surgery in Obese Patients with Colorectal Cancer: A Propensity Score Matching Study

“…From the insertion of four trocars to left colon mobilization and vascular ligations, the early phases of a laparoscopic rectal resection were comparable to those of a left colectomy. Upper rectal cancers were treated with partial mesorectal excision (PME), whereas middle and lower rectal tumors were treated with complete mesorectal excision (TME) [ 15 ]. When coloanal anastomosis was necessary, the anastomosis was done manually or using the Knight-Griffen procedure [ 16 ].…”