en
Scientific article
Open access
English

Results of emergency Hartmann's operation for obstructive or perforated left-sided colorectal cancer

Published inWorld journal of surgical oncology, vol. 6, 90
Publication date2008
Abstract

BACKGROUND: Up to 15% of colorectal cancer (CRC) patients present with obstructive or perforated tumours, and require emergency surgery. The Hartmann's procedure (HP) provides the opportunity to achieve a potentially curative (R0) resection, while minimizing surgical trauma in poor-risk patients. The aim of this study was to assess the surgical (operative mortality), and oncological (long-term survival after curative resection) results of emergency HP for obstructive or perforated left-sided CRC. METHODS: A retrospective review of 50 patients who underwent emergency HP for perforated/obstructive CRC in our institution between 1995 and 2006. RESULTS: Median age of patients was 75 (range 22-95) years and the indications for HP were obstruction (32) and perforation (18 patients). Operative mortality and morbidity were 8% and 26% respectively. 35 patients (70%) were operated with a curative intent; in this group, overall 1-, 3- and 5-year survival rates were 80%, 54% and 40%. In univariate analysis, the presence of lymph node metastases was associated with poor 5-year survival (62% [Stage II] vs. 27% [Stage III], log-rank test, p = 0.02). Eleven patients (22%) had their operation reversed with a median delay of 225 (range 94-390) days. In this subgroup, two patients died from distant metastases, but there were no instances of loco-regional recurrence. CONCLUSION: Hartmann's operation remains a good option to palliate symptoms in 30% of patients with left-sided CRC who are not candidates to a curative resection. For those who have a curative resection, the oncological outcome is acceptable, especially stage II patients, who appear to benefit the most from this surgical strategy.

Keywords
  • Adult
  • Aged
  • Aged, 80 and over
  • Colectomy
  • Colorectal Neoplasms/mortality/surgery
  • Colostomy
  • Emergency Treatment
  • Female
  • Humans
  • Intestinal Obstruction/mortality/surgery
  • Intestinal Perforation/mortality/surgery
  • Male
  • Middle Aged
  • Retrospective Studies
  • Survival Analysis
Citation (ISO format)
CHARBONNET, Pierre et al. Results of emergency Hartmann’s operation for obstructive or perforated left-sided colorectal cancer. In: World journal of surgical oncology, 2008, vol. 6, p. 90. doi: 10.1186/1477-7819-6-90
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Article (Accepted version)
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Identifiers
ISSN of the journal1477-7819
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