Hartmann’s procedure in rectal cancer surgery is often an intraoperative decision: a retrospective multicenter study

Abstract

Purpose This study aimed to investigate patient-related factors predicting the selection of rectal cancer patients to Hartmann’s procedure as well as to investigate how often, and on what grounds, anterior resection is intraoperatively changed to Hartmann’s procedure. Methods Prospectively collected data from the Swedish Colorectal Cancer Registry regarding patients with rectal cancer operated upon from January 1 2007 to June 30 2017 in the county of Skåne were retrospectively reviewed. Data were expanded with further details from medical charts. A univariable analysis was performed to investigate variables associated with unplanned HP and significant variables included in a multivariable logistic regression analysis. Results Altogether, 1141 patients who underwent Hartmann’s procedure (275 patients, 24%), anterior resection (491 patients, 43%), or abdominoperineal resection (375 patients, 33%) were included. Patients undergoing Hartmann’s procedure were significantly older and had more frequently comorbidity. The decision to perform Hartmann’s procedure was made preoperatively in 209 (76%) patients, most commonly because of a comorbidity (27%) or oncological reasons (25%). Patient preference was noted in 8% of cases. In 64 cases (23%), the decision was made intraoperatively, most often due to anastomotic difficulties (60%) and oncological reasons (22%). Anastomotic difficulties were most often reported due to technical difficulties, a low tumor or neoadjuvant radiotherapy. Male gender was a significant risk factor for undergoing unplanned Hartmann’s procedure. Conclusions The decision to perform Hartmann’s procedure was frequently made intraoperatively. Hartmann’s procedure should be considered and discussed preoperatively in old and frail patients, especially in the presence of mid-rectal cancer and/or male gender, since these factors increase the risk of intraoperative anastomotic difficulties.

Therapeutic effects of Buzhong Yiqi decoction in patients with spleen and stomach qi deficiency after routine surgery and chemotherapy for colorectal cancer

“…Its unique advantage lies in its ability to significantly shrink tumor tissues and simultaneously kill hard-to-detect metastatic cells as much as possible, thus significantly reducing the risk of patients’ tumors. Hence, preoperative neoadjuvant chemotherapy creates favorable conditions for subsequent surgery and greatly improves the success rate of surgical resection; however, the postoperative efficacy in some patients is still poor due to the heavy surgical stress reaction of the patients, which is detrimental to the treatment[ 8 ]. Assessing the immune function and inflammatory mediators is crucial for evaluating patients’ recovery status.…”