Abstract
Purpose
Hartmann’s procedure for rectal cancer patients is increasingly performed but few studies have reported the postoperative outcome. The purpose was to report postoperative complications and analyse risk factors in rectal cancer patients operated with Hartmann’s procedure. To describe the selection and postoperative complication patterns, all bowel-resected rectal cancer patients were included.
Methods
Population-based data were from the county of Västmanland, Sweden. All rectal cancer patients operated with an elective bowel resection between 1996 and 2012 were included. Demographics and postoperative complications were prospectively registered and data retrospectively analysed.
Results
Of the 624 patients included, 396 (64 %) were operated with an anterior resection, 159 (25 %) with an abdominoperineal excision and 69 (11 %) a Hartmann’s procedure of which 90 % were low Hartmann’s. Patients operated with a Hartmann’s procedure were significantly older, had higher ASA-score, poorer WHO performance score and lower serum albumin levels. Operative time for Hartmann’s procedure was a median of 49 and 99 min shorter than after anterior resection and abdominoperineal excision, respectively, and entailed less bleeding. Complications related to the pelvic and perineal dissections were more common after abdominoperineal excision compared with anterior resection and Hartmann’s procedure (32 vs. 9 and 13 %, p < 0.001).
Conclusions
Few rectal cancer patients, operated with Hartmann’s procedure, developed pelvic complications despite a higher age, more co-morbidities, metastases in different localities and functional inferiority when compared with the patients operated with anterior resection or abdominoperineal excision. Hartmann’s procedure is a valid alternative procedure in the old and frail rectal cancer patient.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Pahlman L, Bohe M, Cedermark B, Dahlberg M, Lindmark G, Sjodahl R, Ojerskog B, Damber L, Johansson R (2007) The Swedish rectal cancer registry. Br J Surg 94(10):1285–1292
Hosseinali Khani M, Pahlman L, Smedh K (2012) Treatment strategies for patients with stage IV rectal cancer: a report from the Swedish Rectal Cancer Registry. Eur J Cancer 48(11):1616–1623
Frye JN, Carne PW, Robertson GM, Frizelle FA (2004) Abdominoperineal resection or low Hartmann’s procedure. ANZ J Surg 74(7):537–540
Molina Rodriguez JL, Flor-Lorente B, Frasson M, Garcia-Botello S, Esclapez P, Espi A, Garcia-Granero E (2011) Low rectal cancer: abdominoperineal resection or low Hartmann resection? A postoperative outcome analysis. Dis Colon Rectum 54(8):958–962
Tottrup A, Frost L (2005) Pelvic sepsis after extended Hartmann’s procedure. Dis Colon Rectum 48(2):251–255
Smedh K, Olsson L, Johansson H, Aberg C, Andersson M (2001) Reduction of postoperative morbidity and mortality in patients with rectal cancer following the introduction of a colorectal unit. Br J Surg 88(2):273–277
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196
Smedh K, Khani MH, Kraaz W, Raab Y, Strand E (2006) Abdominoperineal excision with partial anterior en bloc resection in multimodal management of low rectal cancer: a strategy to reduce local recurrence. Dis Colon Rectum 49(6):833–840
Sher ME, Bauer JJ, Gorphine S, Gelernt I (1992) Low Hartmann’s procedure for severe anorectal Crohn’s disease. Dis Colon Rectum 35(10):975–980
Acknowledgments
The authors wish to thank Professor Kent Nilsson, Centre for Clinical Research, Uppsala University, for the statistical support.
Compliance with ethical standards funding
The study was supported by a research grant from the county of Västmanland, Sweden.
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
The study was approved by the local ethics committee of Uppsala University, Sweden (Dnr 2013/467) and followed the Declaration of Helsinki guidelines.
Informed consent
All patients in the study have given their informed consent prior to their inclusion in the study as they are all registered in the Swedish Rectal Cancer Registry (SRCR).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sverrisson, I., Nikberg, M., Chabok, A. et al. Hartmann’s procedure in rectal cancer: a population-based study of postoperative complications. Int J Colorectal Dis 30, 181–186 (2015). https://doi.org/10.1007/s00384-014-2069-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-014-2069-6