Abstract：
OBJECTIVE: There is ongoing controversy regarding the extent to which Hartmann\'s procedure (HP) should be used in rectal cancer treatment. This study was designed to investigate 30-day postoperative morbidity and mortality following HP, anterior resection (AR) and abdominoperineal resection (APR) for rectal cancer using a national registry.
METHODS: All patients operated for rectal cancer, tumour height 5-15 cm, between the years 2010 and 2017, were identified through the Swedish colorectal cancer registry.
RESULTS: A total of 8476 patients were included: 1210 (14%) undergoing HP, 5406 (64%) AR and 1860 (22%) APR. HP was associated with an increased risk of intra-abdominal infection (OR 1.7, CI 1.26-2.28, P = 0.0004) compared to AR and APR, while APR was related to an increased risk of overall complications (OR 1.18, CI 1.01-1.40, P = 0.040). No significant difference was observed in the rate of reoperations and readmissions between HP, AR and APR, and type of surgical procedure was not a risk factor for 30-day mortality. Findings from a subgroup analysis of patients with a tumour 5-7 cm from the anal verge revealed that HP was not associated with increased risk for complications or 30-day mortality.
CONCLUSIONS: For patients where AR is not appropriate HP is a valid alternative with a favourable outcome. APR was associated with the highest overall 30-day complication rate.
METHODS: All patients operated for rectal cancer, tumour height 5-15 cm, between the years 2010 and 2017, were identified through the Swedish colorectal cancer registry.
RESULTS: A total of 8476 patients were included: 1210 (14%) undergoing HP, 5406 (64%) AR and 1860 (22%) APR. HP was associated with an increased risk of intra-abdominal infection (OR 1.7, CI 1.26-2.28, P = 0.0004) compared to AR and APR, while APR was related to an increased risk of overall complications (OR 1.18, CI 1.01-1.40, P = 0.040). No significant difference was observed in the rate of reoperations and readmissions between HP, AR and APR, and type of surgical procedure was not a risk factor for 30-day mortality. Findings from a subgroup analysis of patients with a tumour 5-7 cm from the anal verge revealed that HP was not associated with increased risk for complications or 30-day mortality.
CONCLUSIONS: For patients where AR is not appropriate HP is a valid alternative with a favourable outcome. APR was associated with the highest overall 30-day complication rate.
摘要：
目的：关于Hartmann程序（HP）在直肠癌治疗中的应用程度一直存在争议。本研究旨在调查HP术后30天的发病率和死亡率。直肠癌前切除术（AR）和腹会阴切除术（APR）使用国家注册。
方法：所有接受直肠癌手术的患者，肿瘤高度5-15厘米，在2010年至2017年之间，通过瑞典结直肠癌登记处进行了鉴定。
结果：共包括8476例患者：1210例（14％）接受HP，5406（64%）AR和1860（22%）APR。与AR和APR相比，HP与腹腔感染风险增加相关（OR1.7，CI1.26-2.28，P=0.0004），而APR与总体并发症风险增加相关(OR1.18,CI1.01-1.40,P=0.040)。HP之间的再手术率和再入院率没有显着差异，AR和APR，手术类型不是30日死亡率的危险因素.对距肛门边缘5-7厘米的肿瘤患者进行的亚组分析发现，HP与并发症或30天死亡率的增加无关。
结论：对于AR不适合的患者，HP是一种有效的替代方案，具有良好的预后。APR与最高的30天总体并发症发生率相关。
方法：所有接受直肠癌手术的患者，肿瘤高度5-15厘米，在2010年至2017年之间，通过瑞典结直肠癌登记处进行了鉴定。
结果：共包括8476例患者：1210例（14％）接受HP，5406（64%）AR和1860（22%）APR。与AR和APR相比，HP与腹腔感染风险增加相关（OR1.7，CI1.26-2.28，P=0.0004），而APR与总体并发症风险增加相关(OR1.18,CI1.01-1.40,P=0.040)。HP之间的再手术率和再入院率没有显着差异，AR和APR，手术类型不是30日死亡率的危险因素.对距肛门边缘5-7厘米的肿瘤患者进行的亚组分析发现，HP与并发症或30天死亡率的增加无关。
结论：对于AR不适合的患者，HP是一种有效的替代方案，具有良好的预后。APR与最高的30天总体并发症发生率相关。
