Low risk of intra-abdominal infections in rectal cancer patients treated with Hartmann's procedure: a report from a national registry

Int J Colorectal Dis. 2018 Mar;33(3):327-332. doi: 10.1007/s00384-018-2967-0. Epub 2018 Jan 21.

Abstract

Purpose: To describe the postoperative surgical complications in patients with rectal cancer undergoing Hartmann's procedure (HP).

Methods: Data were retrieved from the Swedish Colorectal Cancer Registry for all patients with rectal cancer undergoing HP in 2007-2014. A retrospective analysis was performed using prospectively recorded data. Characteristics of patients and risk factors for intra-abdominal infection and re-laparotomy were analysed.

Results: Of 10,940 patients resected for rectal cancer, 1452 (13%) underwent HP (median age, 77 years). The American Society of Anesthesiologists (ASA) score was 3-4 in 43% of patients; 15% had distant metastases and 62% underwent a low HP. The intra-abdominal infection rate was 8% and re-laparotomy rate was 10%. Multivariable logistic regression analysis identified preoperative radiotherapy (OR, 1.78; 95% CI, 1.14-2.77), intra-operative bowel perforation (OR, 1.99; 95% CI, 1.08-3.67), T4 tumours (OR, 1.68; 95% CI 1.04-2.69) and female gender (OR, 1.73; 95% CI, 1.15-2.61) as risk factors for intra-abdominal infection. ASA score 3-4 (OR, 1.62; 95% CI, 1.12-2.34), elevated BMI (OR, 1.05; 95% CI, 1.02-1.09) and female gender (OR, 2.06; CI, 1.41-3.00) were risk factors for re-laparotomy after HP. The rate of intra-abdominal infection was not increased after a low HP.

Conclusions: Despite older age and co-morbidities including more advanced cancer, patients undergoing Hartmann's procedure had low rates of serious postoperative complications and re-laparotomy. A low HP was not associated with a higher rate of intra-abdominal infection. HP seems to be appropriate for old and frail patients with rectal cancer.

Keywords: Hartmann’s procedure; Intra-abdominal infections; Postoperative complications; Rectal cancer; Surgery.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Digestive System Surgical Procedures / adverse effects*
  • Female
  • Humans
  • Intraabdominal Infections / etiology*
  • Laparotomy
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Postoperative Complications / etiology
  • Rectal Neoplasms / surgery*
  • Registries*
  • Risk Factors
  • Sweden / epidemiology
  • Young Adult