Results of emergency Hartmann's operation for obstructive or perforated left-sided colorectal cancer

Abstract

Background: Up 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.

What Are the Results of Colonic Volvulus Surgery?

“…long-term data on the morbidity and mortality of the hartmann procedure demonstrate a significant disadvantage in subjecting patients to such procedures. [28][29][30][31][32] furthermore, an increasing body of literature regarding the morbidity of protective ileostomy suggests a need to clearly define those patients who benefit from such procedures. [33][34][35][36][37] as such, preoperative planning on patients with volvulus should involve discussion about surgical options, including stoma creation.…”

Colon cancer surgery in patients operated on an emergency basis

“…This fact is explained not only by the patients' deterioration of the clinical status due to the obstructive emergency condition, but also by the advanced stage of the tumor found in such situations 6 . Perforation can occur in 3% to 8% of cases 8 , and although it is a more serious condition and presents greater postoperative morbidity and mortality than colonic obstruction 5 , survival rates are similar in both situations 9 .…”

“…The most commonly used surgical technique in patients with urgently operated CRC is the Hartmann's procedure, because it is a safe technique, especially in patients with a high surgical risk 9 . However, this technique causes several problems of both psychosocial and colostomy-related care.…”

Surgical treatment of complicated colorectal cancer: tactical aspects (a literature review)

“…А. Н. Рыжих, при перфорации рака правой половины толстой кишки рекомендуют правостороннюю геми-колэктомию по Лахею, при левосторонней локализации -резекцию толстой кишки по типу операции Гартмана [6]. По данным P. Charbonnet и соавт., операция Гарт-мана при левостороннем КРР, осложненном перфора-цией, позволяет достичь оптимальных онкологических результатов (отрицательные границы резекции -R0) [68]. При диастатической перфорации супрастенотически расширенных отделов толстой кишки рекомендуется выполнение субтотальной колэктомии [60,69,70].…”