Comparison of a low Hartmann's procedure with low colorectal anastomosis with and without defunctioning ileostomy after radiotherapy for rectal cancer: results from a national registry

Jonker, Frederik H.W.; Tanis, Pieter J.; Coene, Peter-Paul; Gietelink, Lieke; Harst, Erwin van der

doi:10.1111/codi.13281

Cited by 26 publications

(32 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The Dutch group also recently reported that, in patients with rectal cancer selected for RT, low HP was associated with a lower rate of infectious abdominal complications compared with low anterior resection (AR). In that study, 31% of the patients with rectal cancer were excluded because they had T4 tumours, underwent emergency surgery, did not have RT or had missing values [ 14 ]. However, only emergency procedures were excluded in the present study, and the rate of intra-abdominal infection was still low.…”

Section: Discussionmentioning

confidence: 99%

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

Sverrisson

Nikberg

Chabok

et al. 2018

Int J Colorectal Dis

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Sverrisson

Nikberg

Chabok

et al. 2018

Int J Colorectal Dis

View full text Add to dashboard Cite

show abstract

“…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][33][34]. When discussing the treatment plan, we need to ensure that the patient understands all the possible consequences of a diverting stoma.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

Background: One of the most severe complications of low anterior rectal resection is anastomotic leakage (AL). The creation of a loop ileostomy (LI) reduces the prevalence of AL requiring surgical intervention. However, up to one-third of temporary stomas may never be closed. The first aim of the study was to perform a retrospective assessment of the impact of LI on the risk of permanent stoma (PS) and symptomatic AL. The second aim of the study was to assess preoperative PS risk factors in patients with LI. Methods: A total of 286 consecutive patients who underwent low anterior rectal resection were subjected to retrospective analysis. In 101 (35.3%) patients, diverting LI was performed due to low anastomosis, while in the remaining 185 (64.7%) patients, no ileostomy was performed. LIs were reversed after adjuvant treatment. Analyses of the effect of LI on symptomatic AL and PS were performed. Among the potential risk factors for PS, clinical factors and the values of selected peripheral blood parameters were analysed. Results: PS occurred in 37.6% and 21.1% of the patients with LI and without LI, respectively (p < 0.01). Symptomatic ALs were significantly more common in patients without LI. In this group, symptomatic ALs occurred in 23.8% of patients, while in the LI group, they occurred in 5% of patients (p < 0.001). In the LI group, the only significant risk factor for PS in the multivariate analysis was preoperative plasma fibrinogen concentration (OR = 1.007, 97.5% CI 1.002-1.013, p = 0.013). Conclusions: Although protective LI may reduce the incidence of symptomatic AL, it can be related to a higher risk of PS in this group of patients. The preoperative plasma fibrinogen concentration can be a risk factor for PS in LI patients and may be a useful variable in decision-making models.

show abstract

“…Colostomy itself would be more bene cial than a permanent ileostomy. [28,29,30]. When discussing the treatment plan, we need to ensure that the patient understands all the possible consequences of a diverting stoma.…”

Section: Discussionmentioning

confidence: 99%

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

Zeman

Czarnecki

Chmielarz

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundOne of the most severe complications of low anterior resection is anastomotic leakage (AL). The creation of a loop ileostomy (LI) reduces the frequency of AL requiring surgical intervention, but up to one-third of temporary stomas may never be closed.The first aim of the study is to perform a retrospective assessment of the impact of LI on the risk of permanent stoma (PS) and symptomatic AL. The second aim of the study is to assess preoperative PS risk factors in patients with LI.MethodsA total of 286 consecutive patients who underwent low anterior resection were subjected to retrospective analysis. In 101 (35.3%) patients, diverting LI was performed due to low anastomosis, while in the remaining 185 (64.7%) patients, no ileostomy was performed. LIs were reversed after adjuvant treatment. Analyses of the effect of LI on symptomatic AL and PS were performed. Among the potential risk factors for PS, clinical factors and values of selected peripheral blood parameters were analysed.ResultsPS occurred in 37.6% and 21.1% of the patients with LI and without LI, respectively (p <0.01). Symptomatic ALs were significantly more common in patients without LI. In this group, symptomatic ALs occurred in 23.8% of patients, while in the LI group, they occurred in 5% of patients (p <0.001). In the LI group, the only significant risk factor for PS in multivariate analysis was preoperative plasma fibrinogen concentration (OR = 1.008, 97.5% CI 1.003-1.014, p = 0.003).ConclusionsProtective LI significantly reduces the incidence of symptomatic AL, but a higher risk of PS is observed in this group of patients. The preoperative serum fibrinogen concentration is a risk factor for PS in LI patients and may be a helpful variable in decision models.

show abstract

Comparison of a low Hartmann's procedure with low colorectal anastomosis with and without defunctioning ileostomy after radiotherapy for rectal cancer: results from a national registry

Abstract: LHP and LA with DI were associated with fewer infective complications and reoperations than LA alone. The rate of any complication was less after LHR than LA with or without DI.

Cited by 26 publications

References 30 publications

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

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

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

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

Contact Info

Product

Resources

About