Low risk of intra-abdominal infections in rectal cancer patients treated with Hartmann’s procedure: a report from a national registry

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.

Postoperative complications in relation to overall treatment time in patients with rectal cancer receiving neoadjuvant radiotherapy

“…Odds ratios (ORs), calculated by means of logistic regression, are presented as crude and adjusted point estimates with 95 per cent confidence intervals. Co‐variables in the adjusted models were sex, age over 75 years, type of surgery and ASA fitness grade, and were selected based on previous studies showing that male sex, high ASA grade and abdominoperineal excision are associated with higher complication rates. Age was considered a potential confounder as elderly patients might be selected for different waiting intervals in their randomization arm than younger patients.…”

Tumour regression after radiotherapy for rectal cancer – Results from the randomised Stockholm III trial

“…These variables were selected based on data showing that male sex, high ASA-score and APE are associated with more post-operative complications. [279][280][281][282] This clinical knowledge could also affect the decision on timing of surgery. Old age was considered a confounder since elderly patients might be selected to different waiting intervals, and have inferior outcomes when analysed stratified by OTT.…”

Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients

“…In some of these patients, although sphincter preservation was technically possible, an abdominoperineal resection or low Hartmann’s procedure with a permanent colostomy should be considered, as these procedures have a lower risk of postoperative complications. Colostomy would be more beneficial than a permanent ileostomy [ 21 , 32 – 34 ]. When discussing the treatment plan, we need to ensure that the patient understands all the possible consequences of a diverting stoma.…”