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Hartmann's procedure for carcinoma of the rectum and sigmoid colon
W J Adams1, L J Mann, E L Bokey
1University of Sydney, Department of Colon and Rectal Surgery, Concord Hospital, Concord, New South Wales.
Insights
The Hartmann
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Gastrointestinal Oncology
Background:
- Rectal and sigmoid cancers present significant management challenges.
- Surgical resection is a primary treatment modality.
- The Hartmann's procedure is one surgical option for these conditions.
Purpose of the Study:
- To review the utility and outcomes of the Hartmann's procedure.
- To evaluate its role in managing specific patient populations with rectal and sigmoid cancer.
- To provide recommendations for subsequent management, including re-anastomosis.
Main Methods:
- Retrospective review of 1063 patients undergoing resection for rectal or sigmoid carcinoma over 18 years.
- Analysis of patient demographics, tumor characteristics, and surgical approach.
- Identification of patients who underwent Hartmann's procedure (4.4% of total).
Main Results:
- The Hartmann's procedure was utilized in 4.4% of 1063 patients.
- It proved beneficial for patients with proximal obstruction or perforation.
- Effective for elective treatment in elderly, unfit patients with advanced or metastatic disease.
Conclusions:
- The Hartmann's procedure is a valuable option for specific rectal and sigmoid cancer scenarios.
- Re-anastomosis should be considered for fit patients following potentially curative resection.
- Careful patient selection is key to optimizing outcomes with this procedure.
Abstract:
A review of the Hartmann's operation for patients with rectal and sigmoid cancer over an 18 year period is presented. There were 1063 patients who had a resection for carcinoma of the rectum or sigmoid colon and 4.4% of these had a Hartmann's procedure. This operation was particularly useful in the management of patients who presented with a proximal obstruction or perforation at the tumour site. It was also effective in the elective treatment of elderly unfit patients who had locally advanced tumours or those with distant metastases. Re-anastomosis is recommended in those patients who are relatively fit and have had a potentially curative resection.