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[Hartmann's procedure indication in colorectal carcinoma]
I Gastinger1, F Marusch, A Koch
1An-Institut für Qualitätssicherung in der operativen Medizin gGmbH, Otto-von-Guericke-Universität Magdeburg. chirurgie@ctk.de
Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen
|September 28, 2004
Summary
Hartmann's procedure is rarely curative for rectal cancer but offers the lowest mortality for left hemicolon emergencies. Alternative approaches are often preferred for rectal cancer, balancing risks and outcomes.
Area of Science:
- Colorectal surgery
- Surgical oncology
- Gastrointestinal surgery
Context:
- A prospective, multicenter trial analyzed surgical treatments for colorectal carcinomas.
- The study compared Hartmann's procedure with alternatives for rectal and left hemicolon cancer.
- Data included 10,355 patients with rectal carcinoma and 8,825 with left hemicolon carcinoma.
Purpose:
- To evaluate the value and relevance of Hartmann's procedure versus alternative surgical approaches.
- To assess its utility in both elective and emergency settings for rectal and left hemicolon cancer.
Summary:
- Hartmann's procedure was used curatively in only 3.4% of rectal cancer cases, recommended for rare emergencies, high-risk patients, or deep resections.
- For left hemicolon obstruction or perforation, it showed the lowest mortality (7.5%) among radical resection procedures.
- Palliative colostomies were performed in 4.3% of rectal cancer patients.
- Elective left hemicolon surgery favored segmental resection with anastomosis (6.1% mortality, 33.9% morbidity), while Hartmann's procedure was used in emergencies.
Impact:
- Findings guide surgical decision-making for rectal and left hemicolon cancers based on urgency, patient risk, and tumor location.
- Highlights the limited role of Hartmann's procedure in curative rectal cancer treatment.
- Identifies optimal procedures for specific scenarios, aiming to reduce mortality and morbidity in colorectal cancer surgery.