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Abstract：
BACKGROUND: This study aimed to compare low Hartmann\'s procedure (LHP) with abdominoperineal resection (APR) for rectal cancer (RC) regarding postoperative complications.
METHODS: RC patients receiving radical LHP or APR from 2015 to 2019 in our center were retrospectively enrolled. Patients\' demographic and surgical information was collected and analyzed. Propensity score matching (PSM) was used to balance the baseline information. The primary outcome was the incidence of major complications. All the statistical analysis was performed by SPSS 22.0 and R.
RESULTS: 342 individuals were primarily included and 134 remained after PSM with a 1:2 ratio (50 in LHP and 84 in APR). Patients in the LHP group were associated with higher tumor height (P < 0.001). No significant difference was observed between the two groups for the incidence of major complications (6.0% vs. 1.2%, P = 0.290), and severe pelvic abscess (2% vs. 0%, P = 0.373). However, the occurrence rate of minor complications was significantly higher in the LHP group (52% vs. 21.4%, P < 0.001), and the difference mainly lay in abdominal wound infection (10% vs. 0%, P = 0.006) and bowel obstruction (16% vs. 4.8%, P = 0.028). LHP was not the independent risk factor of pelvic abscess in the multivariate analysis.
CONCLUSIONS: Our data demonstrated a comparable incidence of major complications between LHP and APR. LHP was still a reliable alternative in selected RC patients when primary anastomosis was not recommended.
METHODS: RC patients receiving radical LHP or APR from 2015 to 2019 in our center were retrospectively enrolled. Patients\' demographic and surgical information was collected and analyzed. Propensity score matching (PSM) was used to balance the baseline information. The primary outcome was the incidence of major complications. All the statistical analysis was performed by SPSS 22.0 and R.
RESULTS: 342 individuals were primarily included and 134 remained after PSM with a 1:2 ratio (50 in LHP and 84 in APR). Patients in the LHP group were associated with higher tumor height (P < 0.001). No significant difference was observed between the two groups for the incidence of major complications (6.0% vs. 1.2%, P = 0.290), and severe pelvic abscess (2% vs. 0%, P = 0.373). However, the occurrence rate of minor complications was significantly higher in the LHP group (52% vs. 21.4%, P < 0.001), and the difference mainly lay in abdominal wound infection (10% vs. 0%, P = 0.006) and bowel obstruction (16% vs. 4.8%, P = 0.028). LHP was not the independent risk factor of pelvic abscess in the multivariate analysis.
CONCLUSIONS: Our data demonstrated a comparable incidence of major complications between LHP and APR. LHP was still a reliable alternative in selected RC patients when primary anastomosis was not recommended.
摘要：
背景：本研究旨在比较低Hartmann手术（LHP）和腹部手术切除（APR）对直肠癌（RC）术后并发症的影响。
方法：回顾性纳入2015年至2019年在本中心接受根治性LHP或APR的RC患者。收集并分析患者的人口统计学和手术信息。使用倾向评分匹配(PSM)来平衡基线信息。主要结果是主要并发症的发生率。所有统计分析均通过SPSS22.0和R进行。
结果：主要包括342名个体，PSM后保留134名，比例为1：2（LHP为50，APR为84）。LHP组患者肿瘤高度较高(P<0.001)。两组的主要并发症发生率无显著差异（6.0%vs.1.2%,P=0.290),和严重的盆腔脓肿（2％vs.0%,P=0.373)。然而,LHP组轻微并发症的发生率明显高于对照组(52%vs.21.4%,P<0.001)，差异主要在于腹部伤口感染(10%vs.0%,P=0.006）和肠梗阻（16%vs.4.8%，P=0.028)。在多因素分析中，LHP不是盆腔脓肿的独立危险因素。
结论：我们的数据表明，LHP和APR之间的主要并发症发生率相当。当不建议进行初次吻合时，LHP仍然是选定的RC患者的可靠替代方法。
方法：回顾性纳入2015年至2019年在本中心接受根治性LHP或APR的RC患者。收集并分析患者的人口统计学和手术信息。使用倾向评分匹配(PSM)来平衡基线信息。主要结果是主要并发症的发生率。所有统计分析均通过SPSS22.0和R进行。
结果：主要包括342名个体，PSM后保留134名，比例为1：2（LHP为50，APR为84）。LHP组患者肿瘤高度较高(P<0.001)。两组的主要并发症发生率无显著差异（6.0%vs.1.2%,P=0.290),和严重的盆腔脓肿（2％vs.0%,P=0.373)。然而,LHP组轻微并发症的发生率明显高于对照组(52%vs.21.4%,P<0.001)，差异主要在于腹部伤口感染(10%vs.0%,P=0.006）和肠梗阻（16%vs.4.8%，P=0.028)。在多因素分析中，LHP不是盆腔脓肿的独立危险因素。
结论：我们的数据表明，LHP和APR之间的主要并发症发生率相当。当不建议进行初次吻合时，LHP仍然是选定的RC患者的可靠替代方法。
