Second-look surgery following Hartmann's procedure for obstructive left-sided colorectal cancer

Abstract

Abstract. The aim of the present study was to investigate the short-and long-term outcomes of patients undergoing second-look surgery following Hartmann's procedure for obstructive left-sided colorectal cancer (LSCC). All patients included in the present study had undergone radical surgery with Hartmann's procedure for obstructive LSCC. Adjuvant chemotherapy was recommended for all patients, and patients with no signs of recurrence following six months of surveillance were planned to undergo second-look surgery. The aim of second-look surgery was early detection of local recurrence and determination of the efficacy of laparoscopic Hartmann procedure reversal. A total of 15 patients with locally advanced colorectal cancer were included in the study. Three patients exhibited peritoneal dissemination at the time of laparoscopic Hartmann procedure reversal and underwent partial peritonectomy. Following adjuvant chemotherapy treatment, laparoscopic Hartmann procedure reversal was performed in all patients. However, two patients underwent colo-anal anastomosis, and two patients underwent right-sided colon or ileum reconstruction. Regarding the oncological outcomes, two of three patients in whom peritoneal dissemination was identified during laparoscopic Hartmann procedure reversal were eventually in remission following the initial surgery and the second-look surgery with partial peritonectomy. Favorable long-term outcomes were observed in 12/15 patients due to no recurrence, which may be due to the surgical techniques used and the timing of the second-look surgery following Hartmann's procedure for the treatment of obstructive LSCC. IntroductionApproximately 15-20% of patients with left-sided colorectal cancer (LSCC) present with symptoms of acute obstruction (1-4). Patients with obstructive LSCC require emergency surgery, and a high rate of surgical complications and poor prognosis have been reported in these cases (5,6). Emergency management of acute left-sided colonic obstruction remains controversial and at present several treatments options exist, including simple colostomy, primary resection with end colostomy (Hartmann's procedure), one-stage resection anastomosis (subtotal or segmental colectomy) with or without intraoperative colonic irrigation and colonic stenting (7). Emergency surgery for acute colonic obstruction carries a significant risk of mortality and morbidity: The 30-day postoperative mortality rate is 7.6%, with anastomotic dehiscence occurring in 4.9% of cases (2). Thus, 46% of patients require stoma treatment that is permanent (2). To reduce the risk of complications, laparoscopic Hartmann procedure reversal is commonly used for LSCC, since it is considered to reduce the morbidity caused by anastomotic dehiscence (8). However, re-establishing intestinal continuity during laparoscopic Hartmann procedure reversal for LSCC remains a major problem and it carries a serious risk of significant morbidity, with reported anastomotic leak rates of 4-16% and a mortality rate of up to 10% (9,10). Stoma clos...