Hartmann’s procedure in rectal cancer: a population-based study of postoperative complications

Sverrisson, Ingvar; Nikberg, Maziar; Chabok, Abbas; Smedh, K.

doi:10.1007/s00384-014-2069-6

Cited by 35 publications

(44 citation statements)

References 9 publications

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“…However, another current study described an incidence of 3% for pelvic abscesses and an overall pelvic complication rate of 11% associated with HP in rectal cancer patients [11]. This was significantly lower than with APE (32%) although the HP population was older, had more comorbidities, more stage IV disease, and functional inferiority.…”

Section: Discussionmentioning

confidence: 97%

Low Incidence of Pelvic Sepsis after Hartmann’s Procedure: Radiation Therapy May Be a Risk Factor

Wetterhall

Mariusdottir

Hall

et al. 2018

Gastrointest Tumors

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Purpose: Hartmann’s procedure is a well-established alternative in colorectal surgery when a primary anastomosis is contraindicated. However, the rectal remnant may cause complications. This study was designed to investigate the occurrence of pelvic sepsis after Hartmann’s procedure and identify possible risk factors. Methods: All patients who underwent Hartmann’s procedure between 2005 and 2012 were identified by the in-hospital registry. Information about pelvic sepsis and potential preoperative, perioperative, and postoperative risk factors was obtained by review of the medical records. Results: 172 patients were identified (97 females); they were aged 74 ± 11 years. Surgery was performed due to cancer (49%) or diverticulitis (35%) and other benign disease (16%). Rectal transection was carried out anywhere between the pelvic floor and the promontory. Pelvic sepsis developed in 6.4% (11/172) of patients. Pelvic sepsis was associated with preoperative radiotherapy (p = 0.03) and Hinchey grade III and IV (p = 0.02) in those patients who underwent Hartmann’s procedure for diverticular disease. Conclusion: Hartmann’s procedure is a safe operation when an anastomosis is contraindicated since the incidence of pelvic sepsis is low. Preoperative radiotherapy and Hinchey grade III and IV may be risk factors for the development of pelvic sepsis.

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Section: Discussionmentioning

confidence: 97%

Low Incidence of Pelvic Sepsis after Hartmann’s Procedure: Radiation Therapy May Be a Risk Factor

Wetterhall

Mariusdottir

Hall

et al. 2018

Gastrointest Tumors

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“…Although the complication rate after HP is reported to be lower, the risk of pelvic abscesses as a consequence of either an infected haematoma or a blowout of the rectal remnant should not be ignored. The incidence varies from 3 to 30% [18, 35–37]. HP has also been advocated in the palliative setting as an alternative for patients with disseminated disease, where the benefits of symptomatic relief must exceed the risk of morbidity or mortality [17, 19, 31, 36, 38].…”

Section: Discussionmentioning

confidence: 99%

“…In 2007, patients with colon cancer were included and the registry named SCRCR [18]. The SCRCR is a national population-based registry that prospectively collects data for all patients with colorectal cancer.…”

Section: Methodsmentioning

confidence: 99%

The importance of rectal washout for the oncological outcome after Hartmann’s procedure for rectal cancer: analysis of population-based data from the Swedish Colorectal Cancer Registry

2017

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BackgroundDuring rectal cancer surgery the bowel may contain viable, exfoliated cancer cells, a potential source for local recurrence (LR). The amount and viability of these cells can be reduced using intraoperative rectal washout, a procedure that reduces the LR risk after anterior resection. The aim of this study was to analyse the impact of washout on oncological outcome when performed in Hartmann’s procedure (HP) for rectal cancer.MethodsA national cohort study on data for patients registered from 1995 to 2007 in the Swedish Colorectal Cancer Registry was carried out. The final analysis included patients belonging to TNM stages I–III who had undergone R0 HP with a registered 5-year follow-up. Multivariate analysis was performed.ResultsA total of 1188 patients were analysed (686 washout and 502 no washout). No differences were detected between the washout group and the no washout group concerning rates of LR [7% (49/686) vs. 10% (49/502); p = 0.13], distant metastasis (DM) [17% (119/686) vs. 18% (93/502); p = 0.65], and overall recurrence (OAR) [21% (145/686) vs. 24% (120/502); p = 0.29]. For both groups, the 5-year cancer-specific survival was below 50%. In multivariate analysis, washout neither decreased the risk of LR, DM, or OAR nor increased overall or the cancer-specific 5-year survival.ConclusionsThe oncological outcome did not improve when washout was performed in HP for rectal cancer.Electronic supplementary materialThe online version of this article (doi:10.1007/s10151-017-1637-5) contains supplementary material, which is available to authorized users.

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“…The role of the protective stoma is controversial, but it is accepted that stoma can reduce the incidence of AL [4,18,19,23]. However, the new method of PNA which we describe in our study showed that it is a good alternative for multi-stage complex restorative operation.…”

Section: Figurementioning

confidence: 59%

“…The second stage -reconstructive surgery is one of the most complicated operation in abdominal surgery with a high percentage of postoperative complications. The frequency restoration of physiologic passage through the colon can be performed only in 30-40% of patients [18,19].…”

Section: Introductionmentioning

confidence: 99%

The Evaluation of Risk Factors of Anastomotic Leakage in Patients With Colorectal Cancer Complicated by Ileus

Grytsenko¹,

Bedeniuk²,

Grytsenko³

et al. 2017

Int J Surg Med

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Background: Obstructive ileus and peritonitis are the most frequent complication of colorectal cancer, manifested in 8-40% cases. Anastomotic leakage (AL) is a fatal complication in colorectal surgery. In our study, we aim to analyse the safety, outcomes in patients with colon obstruction after resection with new anastomosis technique implementation and to identify prognostic value of each risk factor on the development of AL. Methods: A retrospective analysis of prospectively acquired data of 155 consecutive emergency patients with cancer of the proximal rectum and sigmoid colon complicated by chronic bowel obstruction in the stage of subcompensation and decompensation were included in our study and divided into two groups. In the basic group (n=95), primary nonfunctional anastomosis (PNA) was performed after resection of the rectum. In the comparing group (n=60), resection of the colon or rectum with primary anastomosis was performed. Results: Postoperative complications have arisen in 5(5,3%) patients of group I and 11 (18,4%) patients of group II. AL was developed only in 1 patient in the basic group (1,1%) and in 7 (11,7%) patients of the compared group on the 5 th -12 th day after the operation. We have worked out the rating score of risk factors of AL.A score was given for each AL factor which we had selected for the elaboration of this scale. Conclusions: Based on AL risk factors scale we highlighted five levels of risk which have significant clinical meaning and help surgeons decide finally how to finish operation in a patient with bowel obstruction to avoid AL. PNA with preventive transversostoma was shown to provide adequate decompression of the colon, reliable prevention of colorectal AL and avoid complex reconstructive operations.KEYWORDS: colorectal cancer, bowel obstruction, anastomotic leakage.

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Hartmann’s procedure in rectal cancer: a population-based study of postoperative complications

Cited by 35 publications

References 9 publications

Low Incidence of Pelvic Sepsis after Hartmann’s Procedure: Radiation Therapy May Be a Risk Factor

Low Incidence of Pelvic Sepsis after Hartmann’s Procedure: Radiation Therapy May Be a Risk Factor

The importance of rectal washout for the oncological outcome after Hartmann’s procedure for rectal cancer: analysis of population-based data from the Swedish Colorectal Cancer Registry

The Evaluation of Risk Factors of Anastomotic Leakage in Patients With Colorectal Cancer Complicated by Ileus

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