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Title

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

Authors
Bucher, Pascal
Konrad, Béatrice
Published in World Journal of Surgical Oncology. 2008, vol. 6, p. 90
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 AdultAgedAged, 80 and overColectomyColorectal Neoplasms/mortality/surgeryColostomyEmergency TreatmentFemaleHumansIntestinal Obstruction/mortality/surgeryIntestinal Perforation/mortality/surgeryMaleMiddle AgedRetrospective StudiesSurvival Analysis
Identifiers
PMID: 18721476
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Research group Chirurgie viscérale (104)
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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. https://archive-ouverte.unige.ch/unige:1230

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Deposited on : 2009-03-26

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