Low rectal cancer: abdominoperineal resection or low Hartmann resection? A postoperative outcome analysis

In distal rectum cancers, when the sphincters are not affected and it is not possible to perform a coloanal anastomosis because of the presence of comorbidities or the advanced age of the patient, a low Hartmann resection with total mesorectal excision can be performed. Low Hartmann resection is usually considered to be a shorter procedure and to have an inferior morbidity compared with abdominoperineal resection of the rectum.

This study aimed to compare the postoperative outcome of a series of patients with low rectal cancer who have undergone either low Hartmann resection or abdominoperineal resection.

This study is a retrospective analysis of data collected in a prospective database.

This study was conducted in a specialized Colorectal Unit, Department of Surgery, of a tertiary teaching hospital.

Patients who underwent low Hartmann or abdominoperineal resection for rectal cancer between 1996 and 2009 at our specialized Colorectal Unit were considered.

The main interventions were low Hartmann resection vs abdominoperineal resection.

The main outcome measures were 60-day morbidity and mortality.

The pelvic abscess rate was 12.2% in patients who underwent low Hartmann resection and 3.0% in those who underwent abdominoperineal resection (P = .02). The reoperation rate was 14.6% in the Hartmann group and 3.8% in the abdominoperineal group (P = .013). The rehospitalization rates in the Hartmann and abdominoperineal groups were 7.3% and 0.7% (P = .015). No differences were found in the other variables analyzed. At multivariate analysis, the surgical technique performed was the only independent risk factor for pelvic abscess development, readmission, and reoperation.

: This study was limited by its retrospective nature.

In our series, low Hartmann resection was associated with higher pelvic abscess, reoperation, and readmission rates. These findings suggest that in patients with rectal cancer without sphincter infiltration and who are unsuitable for coloanal anastomosis, abdominoperineal resection should be a valid alternative to low Hartmann resection.