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

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

Ingvar Sverrisson  1 , Maziar Nikberg  2 , Abbas Chabok  2 , Kenneth Smedh  2
Affiliations

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

Ingvar Sverrisson et al. Int J Colorectal Dis. 2018 Mar.

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.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by The Regional Ethics Review Board in Uppsala (No. 2012/558) and followed the principles of the Declaration of Helsinki.

Informed consent

Informed consent was obtained at the time of inclusion in the registry from all individual participants in the study.

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