Low Hartmann’s procedure or intersphincteric abdominoperineal resection in the primary treatment of low rectal cancer; a survey among surgeons evaluating current practice

Westerduin, E.; Westerterp, Marinke; Bemelman, Willem A.; Tanis, Pieter J.; Geloven, Anna Aw van

doi:10.1080/00015458.2018.1515338

Cited by 3 publications

(6 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The choice between LH and ISAPR is ultimately dependent on the surgeon preference and comfort with the procedure in question has a large impact on the choice. A recent Dutch survey found that 86% of surgeons preferred ISAPR to LH, demonstrating a significant shift in preferences compared to a similar study 5 years earlier 22 . While no reasons where given for this change, it is likely that the recent reports of favourable outcomes following ISAPR contributed to this.…”

Section: Discussionmentioning

confidence: 92%

See 1 more Smart Citation

The complication profile of low Hartmann's in rectal cancer: a systematic review and meta‐analysis

Choy

Lee

Prabhakaran

et al. 2022

ANZ Journal of Surgery

View full text Add to dashboard Cite

Background Non‐restorative options for low rectal cancer not invading the sphincter includes low Hartmann's procedure (LH) and inter‐sphincteric abdominoperineal resection (ISAPR). There is currently little comparative data to differentiate these options. Objectives The aim of this review was to assess the peri‐operative morbidity of LH, and then to compare it to that of ISAPR. Data Sources An up‐to‐date systematic review was performed on the available literature between 2000–2020 on PubMed, EMBASE, Medline, and Cochrane Library databases. Study Selection All studies reporting on non‐restorative surgeries for rectal cancer were analysed. Outcomes were firstly analysed between LH and non‐LH groups, with further sub‐analysis comparing the LH and ISAPR groups. Main outcome measure The main outcome measures were the rates of pelvic sepsis, rates of overall post‐operative complication rates, oncological outcomes, and survival. Results A total of 12 observational studies were included. There were 3526 patients (61.1%) in the LH group, and 2238 patients (38.9%) in the non‐LH group, which included 461 patients who underwent ISAPR. The LH group had a higher rate of pelvic sepsis as compared to the non‐LH group (OR: 1.79, 95% CI: 1.39–2.29, P < 0.001). The difference is more marked in the sub‐analysis comparing LH and ISAPR alone (OR: 3.94, 95% CI: 1.88–7.84, P < 0.01) corresponding to a higher rate of unplanned re‐intervention. LH was associated with a higher rate of short‐term post‐operative mortality as compared to the non‐LH group. Conclusion ISAPR is the preferred option for non‐restorative rectal surgery, with a more favourable peri‐operative morbidity and short‐term mortality profile as compared to LH.

show abstract

Section: Discussionmentioning

confidence: 92%

“…A recent Dutch survey found that 86% of surgeons preferred ISAPR to LH, demonstrating a significant shift in preferences compared to a similar study 5 years earlier. 22 While no reasons where given for this change, it is likely that the recent reports of favourable outcomes following ISAPR contributed to this.…”

Section: Discussionmentioning

confidence: 99%

The complication profile of low Hartmann's in rectal cancer: a systematic review and meta‐analysis

Choy

Lee

Prabhakaran

et al. 2022

ANZ Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…In this UK cohort there was a tendency for surgeons to perform HP rather than IAPE. This is in contrast to European units where IAPE is the preferred technique in this setting [11]. The reasons for avoiding an anastomosis were as expected: the risk of pelvic sepsis from an anastomotic leak, concerns over poor function and/or frailty.…”

Section: Discussionmentioning

confidence: 92%

“…There have been no prospective comparisons of the two procedures and no data on patient‐reported outcomes, which may be much more important than perceived morbidity. A recent survey of Dutch colorectal surgeons supported the perception that HP was associated with an unacceptably high rate of pelvic abscess and that IAPE should be the preferred procedure in this setting [11].…”

Section: Introductionmentioning

confidence: 99%

Hartmann's procedure versus intersphincteric abdominoperineal excision (HiP Study): a multicentre prospective cohort study

et al. 2020

View full text Add to dashboard Cite

Aim In patients with low rectal cancer it is occasionally necessary to avoid a low coloanal anastomosis due to patient frailty or poor function. In such situations there are two alternative approaches: Hartmann's procedure (HP) or intersphincteric abdominoperineal excision (IAPE). There are few data to guide surgeons as to which of these two procedures is the safest. The aim of this study was to determine the surgical complication rates associated with each procedure. Method This was a multicentre, nonrandomized prospective cohort study of patients undergoing either HP or IAPE. The primary objective was to determine surgical complication rates. Secondary objectives included length of stay, time to adjuvant therapy and quality of life at 90 days. Results One hundred and seventy nine patients were recruited between April 2016 and June 2019; approximately two thirds of patients underwent HP and one third IAPE. The overall complication rate was high in both groups (54% for the HP group and 52% for the IAPE group). Surgery-specific complication rates were also high, but not significantly different: 43% for HP and 48% for IAPE. The pelvic abscess rate in HP was 11% and was significantly higher in patients with a palpable staple line (15% vs 2%). There was a higher incidence of serious medical complications following IAPE (16% vs 5%), along with a reduction in 90-day quality of life scores. Conclusion This is the largest prospective study to compare HP and IAPE in patients undergoing rectal cancer surgery where primary anastomosis is not deemed appropriate. With similar complication rates, these data support the ongoing use of either HP or IAPE in this patient group.

show abstract

“…Due to distal rectum closure and proximal endo-colostomy, it was traditionally regarded as one safer procedure and was often performed for those with a poor physical condition. It was associated with less surgical trauma and faster recovery [ 5 ]. In recent years, the term “low Hartmann’s procedure (LHP)” has been proposed, and it mainly refers to the procedure for tumors located within 10 cm of the anal verge [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Low Hartmann’s procedure versus abdominoperineal resection for rectal cancer, a propensity score matching cohort study

Zhang,

Liu,

Liu

et al. 2024

BMC Gastroenterol

View full text Add to dashboard Cite

Background This study aimed to compare low Hartmann’s procedure (LHP) with abdominoperineal resection (APR) for rectal cancer (RC) regarding postoperative complications. Method RC patients receiving radical LHP or APR from 2015 to 2019 in our center were retrospectively enrolled. Patients’ demographic and surgical information was collected and analyzed. Propensity score matching (PSM) was used to balance the baseline information. The primary outcome was the incidence of major complications. All the statistical analysis was performed by SPSS 22.0 and R. Results 342 individuals were primarily included and 134 remained after PSM with a 1:2 ratio (50 in LHP and 84 in APR). Patients in the LHP group were associated with higher tumor height (P < 0.001). No significant difference was observed between the two groups for the incidence of major complications (6.0% vs. 1.2%, P = 0.290), and severe pelvic abscess (2% vs. 0%, P = 0.373). However, the occurrence rate of minor complications was significantly higher in the LHP group (52% vs. 21.4%, P < 0.001), and the difference mainly lay in abdominal wound infection (10% vs. 0%, P = 0.006) and bowel obstruction (16% vs. 4.8%, P = 0.028). LHP was not the independent risk factor of pelvic abscess in the multivariate analysis. Conclusion Our data demonstrated a comparable incidence of major complications between LHP and APR. LHP was still a reliable alternative in selected RC patients when primary anastomosis was not recommended.

show abstract

Low Hartmann’s procedure or intersphincteric abdominoperineal resection in the primary treatment of low rectal cancer; a survey among surgeons evaluating current practice

Cited by 3 publications

References 18 publications

The complication profile of low Hartmann's in rectal cancer: a systematic review and meta‐analysis

The complication profile of low Hartmann's in rectal cancer: a systematic review and meta‐analysis

Hartmann's procedure versus intersphincteric abdominoperineal excision (HiP Study): a multicentre prospective cohort study

Low Hartmann’s procedure versus abdominoperineal resection for rectal cancer, a propensity score matching cohort study

Contact Info

Product

Resources

About