uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Hartmann's procedure in rectal cancer: a population-based study of postoperative complications
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
2015 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 30, no 2, p. 181-186Article in journal (Refereed) Published
Abstract [en]

Hartmann's procedure for rectal cancer patients is increasingly performed but few studies have reported the postoperative outcome. The purpose was to report postoperative complications and analyse risk factors in rectal cancer patients operated with Hartmann's procedure. To describe the selection and postoperative complication patterns, all bowel-resected rectal cancer patients were included. Population-based data were from the county of Vastmanland, Sweden. All rectal cancer patients operated with an elective bowel resection between 1996 and 2012 were included. Demographics and postoperative complications were prospectively registered and data retrospectively analysed. Of the 624 patients included, 396 (64 %) were operated with an anterior resection, 159 (25 %) with an abdominoperineal excision and 69 (11 %) a Hartmann's procedure of which 90 % were low Hartmann's. Patients operated with a Hartmann's procedure were significantly older, had higher ASA-score, poorer WHO performance score and lower serum albumin levels. Operative time for Hartmann's procedure was a median of 49 and 99 min shorter than after anterior resection and abdominoperineal excision, respectively, and entailed less bleeding. Complications related to the pelvic and perineal dissections were more common after abdominoperineal excision compared with anterior resection and Hartmann's procedure (32 vs. 9 and 13 %, p < 0.001). Few rectal cancer patients, operated with Hartmann's procedure, developed pelvic complications despite a higher age, more co-morbidities, metastases in different localities and functional inferiority when compared with the patients operated with anterior resection or abdominoperineal excision. Hartmann's procedure is a valid alternative procedure in the old and frail rectal cancer patient.

Place, publisher, year, edition, pages
2015. Vol. 30, no 2, p. 181-186
Keywords [en]
Abdominoperineal excision, Anterior resection, Hartmann's procedure, Rectal cancer, Surgery, Pelvic sepsis, Postoperative complications
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-245348DOI: 10.1007/s00384-014-2069-6ISI: 000348222400004PubMedID: 25421100OAI: oai:DiVA.org:uu-245348DiVA, id: diva2:791438
Available from: 2015-02-27 Created: 2015-02-26 Last updated: 2018-10-08Bibliographically approved
In thesis
1. Rectal cancer: Aspects of post-operative complications
Open this publication in new window or tab >>Rectal cancer: Aspects of post-operative complications
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to study post-operative complications in patients with rectal cancer.

Methods: Post-operative complications in patients operated for rectal cancer was retrospectively analyzed in three prospective registers; the local rectal cancer registry in the Västmanland County, Sweden, the Swedish Colorectal Cancer Registry (SCRCR) and the National Prostate Cancer Registry (NPCR). In Papers I and II, the focus was on the complication pattern after Hartmann’s procedure (HP). In Paper III, the incidence of parastomal hernia was assessed during a period when no prophylactic mesh was used (1996-2006) compared with a period when a prophylactic mesh was routinely used (2007-2012). In Paper IV, the anastomotic leakage (AL) rate after anterior resection (AR) for rectal cancer patients who had previously received RT for prostate cancer was assessed with combined data from the SCRCR and the NPCR.

Results: In Paper I, patients operated with a HP were significantly older, had a higher ASA-score, a poorer WHO performance score and lower serum albumin levels. Few developed pelvic complications. In Paper II, the intra-abdominal infection rate was 8% and the re-laparotomy rate was 10%. Multi-variable logistic regression analysis identified pre-operative radiotherapy as a risk factor for intra-abdominal infections. In Paper III, we found no difference in the rate of parastomal hernia between patients with and without a prophylactic stoma mesh. In Paper IV, we identified 59 out of 188 patients who had undergone previous radiation therapy for prostate cancer who had been operated with AR. Twelve (20%) developed an AL, of whom only one underwent re-laparotomy and there was no 90-day mortality.

Conclusion: The rate of serious post-operative complications was low after HP and it seems to be a safe and appropriate alternative in old and frail patients. Pre-operative radiotherapy was a risk factor for intra-abdominal infections in rectal cancer patients operated with a HP. A prophylactic stoma mesh did not reduce the rate of parastomal hernias. In patients that had previously been irradiated for prostate cancer, a minority underwent an AR. These patients were healthy with early cancer stages and, in this selected group of patients, the AL rate was much lower than previously reported.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 59
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1505
Keywords
Rectal cancer, Complications, Anastomotic leakage, Abscess, Parastomal hernia, Prostate cancer, Radiation therapy
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-362704 (URN)978-91-513-0469-4 (ISBN)
Public defence
2018-11-29, Aulan, entrance 21, Västmanlands Hospital, Västerås, Västerås, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-11-06 Created: 2018-10-08 Last updated: 2018-11-19

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMed

Authority records BETA

Sverrisson, IngvarChabok, AbbasSmedh, Kenneth

Search in DiVA

By author/editor
Sverrisson, IngvarChabok, AbbasSmedh, Kenneth
By organisation
Colorectal SurgeryCentre for Clinical Research, County of Västmanland
In the same journal
International Journal of Colorectal Disease
Surgery

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 550 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf