Sverrisson I, et al. - This study was performed to describe the postoperative surgical complications in patients with rectal cancer undergoing Hartmann’s procedure (HP). Patients undergoing Hartmann’s procedure had low rates of serious postoperative complications and re-laparotomy, despite older age and co-morbidities including more advanced cancer. A low HP was not correlated with a higher rate of intra-abdominal infection. For old and frail patients with rectal cancer, HP seemed to be appropriate.

Methods

• Researchers retrieved data from the Swedish Colorectal Cancer Registry for all patients with rectal cancer undergoing HP in 2007–2014.
• Using prospectively recorded data, a retrospective analysis was performed.
• They examined characteristics of patients and risk factors for intra-abdominal infection and re-laparotomy.

Results

• A total of 1,452 patients (13%) underwent HP (median age, 77 years) among 10,940 patients resected for rectal cancer.
• In 43% of patients, the American Society of Anesthesiologists (ASA) score was 3-4; 15% had distant metastases and 62% underwent a low HP.
• In this study, the intra-abdominal infection rate was 8% and re-laparotomy rate was 10%.
• In multivariable logistic regression analysis, 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) were identified as risk factors for intra-abdominal infection.
• Risk factors for re-laparotomy after HP were 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).
• No increase in the rate of intra-abdominal infection was noted after a low HP.