The complication profile of low Hartmann's in rectal cancer: a systematic review and meta-analysis
- Author(s)
- Choy, KT; Lee, DJ; Prabhakaran, S; Warrier, S; Heriot, A; Kong, JC;
- Details
- Publication Year 2022-11,Volume 92,Issue #11,Page 2829-2839
- Journal Title
- ANZ Journal of Surgery
- Publication Type
- Review
- Abstract
- BACKGROUND: Non-restorative options for low rectal cancer not invading the sphincter includes low Hartmann's procedure (LH) and inter-sphincteric abdominoperineal resection (ISAPR). There is currently little comparative data to differentiate these options. OBJECTIVES: The aim of this review was to assess the peri-operative morbidity of LH, and then to compare it to that of ISAPR. DATA SOURCES: An up-to-date systematic review was performed on the available literature between 2000-2020 on PubMed, EMBASE, Medline, and Cochrane Library databases. STUDY SELECTION: All studies reporting on non-restorative surgeries for rectal cancer were analysed. Outcomes were firstly analysed between LH and non-LH groups, with further sub-analysis comparing the LH and ISAPR groups. MAIN OUTCOME MEASURE: The main outcome measures were the rates of pelvic sepsis, rates of overall post-operative complication rates, oncological outcomes, and survival. RESULTS: A total of 12 observational studies were included. There were 3526 patients (61.1%) in the LH group, and 2238 patients (38.9%) in the non-LH group, which included 461 patients who underwent ISAPR. The LH group had a higher rate of pelvic sepsis as compared to the non-LH group (OR: 1.79, 95% CI: 1.39-2.29, P < 0.001). The difference is more marked in the sub-analysis comparing LH and ISAPR alone (OR: 3.94, 95% CI: 1.88-7.84, P < 0.01) corresponding to a higher rate of unplanned re-intervention. LH was associated with a higher rate of short-term post-operative mortality as compared to the non-LH group. CONCLUSION: ISAPR is the preferred option for non-restorative rectal surgery, with a more favourable peri-operative morbidity and short-term mortality profile as compared to LH.
- Keywords
- Humans; *Rectal Neoplasms; Rectum/surgery; *Proctectomy/adverse effects; Colostomy/adverse effects; Postoperative Complications/epidemiology/etiology; *Sepsis; Treatment Outcome; Anastomosis, Surgical/adverse effects/methods; inter-sphincteric abdominopelvic resection; low Hartmann's; non-restorative rectal surgery
- Department(s)
- Surgical Oncology; Laboratory Research
- PubMed ID
- 35727062
- Publisher's Version
- https://doi.org/10.1111/ans.17827
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-10-16 06:19:38
Last Modified: 2024-10-16 06:21:19