Low Incidence of Pelvic Sepsis after Hartmann’s Procedure: Radiation Therapy May Be a Risk Factor

Wetterhall, Carmela; Mariusdottir, Elin; Hall, Claire; Jörgren, Fredrik; Buchwald, Pamela

doi:10.1159/000493526

Cited by 10 publications

(10 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The present study showed that neoadjuvant RT increased the risk of pelvic sepsis after HP, in line with previous studies (14,(19)(20)(21) indicating that neoadjuvant RT causes defective wound healing and subsequently increases the risk of pelvic sepsis. Although neoadjuvant RT was a risk factor for pelvic sepsis development in a large study from the Dutch surgical audit it did not affect the overall reinvention rate or mortality (14).…”

Section: Discussionsupporting

confidence: 93%

Low Incidence of Pelvic Sepsis Following Hartmann’s Procedure for Rectal Cancer – A Retrospective Multicentre Study

Mariusdottir

Jörgren

Mondlane

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

Background Results of previous studies regarding pelvic sepsis after Hartmann’s procedure (HP) for rectal cancer have been inconsistent and few studies report the risk factors. This study aimed to investigate the incidence of pelvic sepsis after HP, identify risk factors and describe when as well as how pelvic sepsis was diagnosed and treated. Methods Data were collected from the Swedish Colorectal Cancer Registry on all patients undergoing HP for rectal cancer in the county of Skåne from 2007–2017. Patients diagnosed with pelvic sepsis were compared with patients without pelvic sepsis and risk factors for developing pelvic sepsis were analysed in a multivariable model. Results A total of 252 patients were included in the study, with 149 (59%) males, and a median age of 75 years (range 20–92). Altogether, 27 patients (11%) were diagnosed with pelvic sepsis. Risk factors for developing pelvic sepsis were neoadjuvant radiotherapy (OR 7.96, 95% CI 2.54–35.36) and BMI over 25 kg/m2 (OR 5.26, 95% CI 1.80–19.50). Median time from operation to diagnosis was 21 days (range 5-355) with 11 (40%) patients diagnosed beyond 30 days postoperatively. The majority of cases 19 (70%) were treated conservatively and none needed major surgery. Conclusion Pelvic sepsis occurred in 11% of patients. Neoadjuvant radiotherapy and higher BMI were significant risk factors for developing pelvic sepsis. Forty percent of patients were diagnosed later than 30 days postoperatively and most patients were successfully treated conservatively. Our findings suggest that HP is a valid treatment option for rectal cancer when anastomosis is inappropriate, even in patients receiving neoadjuvant radiotherapy.

show abstract

Section: Discussionsupporting

confidence: 93%

Low Incidence of Pelvic Sepsis Following Hartmann’s Procedure for Rectal Cancer – A Retrospective Multicentre Study

Mariusdottir

Jörgren

Mondlane

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…1,5,7 Seven studies compared LH with APR/ISAPR, 2,3,6,8,9,12,13 with three studies comparing LH with restorative anterior resection. 10,11,14 Two studies focused on outcomes of LH alone 15,16 underwent restorative bowel resections as well as 461 patients who underwent APR/ISAPR. Given the low number of papers allowing for direct comparison with ISAPR, all seven studies comparing LH with APR/ISAPR were referred to as the ISAPR group.…”

Section: Search Results and Included Studiesmentioning

confidence: 99%

“…Seven studies compared LH with APR/ISAPR, 2,3,6,8,9,12,13 with three studies comparing LH with restorative anterior resection 10,11,14 . Two studies focused on outcomes of LH alone 15,16 (Table 2). This yielded a total of 5764 patients, with 3526 (61.1%) patients undergoing LH (including 91 for non‐malignant indications) and 2238 (38.9%) patients in the non‐LH group.…”

Section: Resultsmentioning

confidence: 99%

“…All studies included radiological and surgical interventional data with regards to unplanned reinterventions. 12 TME was performed, and the rectum divided at the pelvic floor at ⩽6 cm above the anal verge Westerduin et al (2017) 6 TME, creating a small rectal stump and an end colostomy Sverrisson et al (2015) 2 Defined as transection of the rectum below the peritoneal reflection just above the levator ani Rodriguez et al 3 No definition Frye et al (2004) 13 Resection below the anterior rectal peritoneal reflection down as close as technically possible to the anorectal junction, at which level the rectum was stapled and transected Heah et al (1997) 9 No definition LH alone Wetterhall et al (2018) 15 Resection of the sigmoid colon and/or rectum where transection is performed above the anal canal, and the anorectal remnant is closed subsequently, leaving the patient with an end stoma Sverrisson et al (2018) 16 Transection of the rectum just above or at the pelvic floor LH versus restorative resection Roodbeen et al (2020) 10 Rectal resection with cross-stapling of the rectal stump and formation of an end colostomy Jonker et al(2016) 28 Removal of most of the rectum to leave a short anorectal stump and an end colostomy Timofeiov et al (2014) 29 Surgical resection of the rectosigmoid colon with closure of the rectal stump and end colostomy; mesorectal excision after ligation of the inferior mesenteric vessels at the origin or above the emergence of the left colic artery. The closure of the rectal stump can be done mechanically (mid rectal cancer) or manually (upper rectal cancer).…”

Section: Selection Of Studiesmentioning

confidence: 99%

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

“…This may be due to the damage of immune system of anti-infection and anti-tumor immunity [34]. In addition, PCT usually causes anastomotic in ammation and edema, resulting in relative anastomotic ischemia, local in ammation and tissue brosis, which is not conducive to anastomotic healing and increase the risk of AL [35,36].…”

Section: Discussionmentioning

confidence: 99%

Hyperuricemia May Affect the Healing of Anastomosis in Dixon Surgery for Rectal Cancer: A Retrospective Study

Zheng

2021

Preprint

View full text Add to dashboard Cite

Background：The impact of Hyperuricemia (HUA) on Dixon surgery is rarely reported. Anastomotic leakage (AL) is the main serious complication in Dixon surgery. We discussed the relationship between HUA and AL. Our aim was to identify these factors to provide intervention measures for clinical practice.Methods：The clinical data of 1147 patients who underwent Dixon operation for rectal cancer in the Second Affiliated Hospital of Fujian Medical University from January 2009 to December 2018 were retrospectively analyzed. Rank sum test was used for measurement data, and χ2 test was used for counting data. In univariate analysis, significant variables (P < 0.05) were used for multivariate analysis, and multivariable logistic regression was used to examine their independent roles. All tests were 2-sided, P<0.05 was considered statistically significant.Results：A total of 1147 patients with rectal cancer undergoing Dixon operation were included in the study, including 153 patients with HUA and 994 patients with normal uric acid (UA). The AL was 148 cases (14.9%) in UA group and 37 cases (24.2%) in HUA group. There was significant difference in AL (P = 0.006). The influence of HUA (P = 0.006), Tumor distance from the anal margin (TD) (P = 0.024) and preoperative chemoradiotherapy (PCT) (P = 0.040) on AL were significantly different. Logistic analysis showed that HUA (P = 0.021) and TD (P = 0.014) had significant effects on AL. In rectal cancer group with HUA, there were significant differences in the effects of male (P = 0.035), body mass index (BMI) (P = 0.017) and PCT (P = 0.013) on AL. Logistic analysis showed that there were significant differences between male (P = 0.001) and PCT (P = 0.004) on AL.Conclusions：HUA is an independent risk factor of AL in Dixon operation for rectal cancer. In patients with HUA undergoing Dixon operation, gender, BMI and PCT have significant difference on AL. Male and PCT are independent risk factors of AL.

show abstract

Low Incidence of Pelvic Sepsis after Hartmann’s Procedure: Radiation Therapy May Be a Risk Factor

Cited by 10 publications

References 12 publications

Low Incidence of Pelvic Sepsis Following Hartmann’s Procedure for Rectal Cancer – A Retrospective Multicentre Study

Low Incidence of Pelvic Sepsis Following Hartmann’s Procedure for Rectal Cancer – A Retrospective Multicentre Study

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

Hyperuricemia May Affect the Healing of Anastomosis in Dixon Surgery for Rectal Cancer: A Retrospective Study

Contact Info

Product

Resources

About