Postoperative morbidity following Hartmann's procedure in comparison to anterior resection and abdominoperineal resection for rectal cancer—a population‐based study

Abstract

AimThere is ongoing controversy regarding the extent to which Hartmann's procedure (HP) should be used in rectal cancer treatment. This study was designed to investigate 30‐day postoperative morbidity and mortality following HP, anterior resection (AR) and abdominoperineal resection (APR) for rectal cancer using a national registry.MethodsAll patients operated for rectal cancer, tumour height 5–15 cm, between the years 2010 and 2017, were identified through the Swedish colorectal cancer registry.ResultsA total of 8476 patients were included: 1210 (14%) undergoing HP, 5406 (64%) AR and 1860 (22%) APR. HP was associated with an increased risk of intra‐abdominal infection (OR 1.7, CI 1.26–2.28, P = 0.0004) compared to AR and APR, while APR was related to an increased risk of overall complications (OR 1.18, CI 1.01–1.40, P = 0.040). No significant difference was observed in the rate of reoperations and readmissions between HP, AR and APR, and type of surgical procedure was not a risk factor for 30‐day mortality. Findings from a subgroup analysis of patients with a tumour 5–7 cm from the anal verge revealed that HP was not associated with increased risk for complications or 30‐day mortality.ConclusionsFor patients where AR is not appropriate HP is a valid alternative with a favourable outcome. APR was associated with the highest overall 30‐day complication rate.