Low risk of pelvic sepsis after intersphincteric proctectomy in patients with low rectal cancer

Pelvic sepsis after Hartmann's procedure for low rectal cancer is a frequent complication. It has been reported at a frequency of 12.2-17.2% and has even reached 33% when the transection level of the rectum is ≤ 2 cm from the anal verge. The aim of this study was to examine whether intersphincteric proctectomy reduces the frequency of pelvic sepsis in patients operated with an extended Hartmann's procedure for rectal cancer.

Patients undergoing elective extended Hartmann's procedure with an intersphincteric proctectomy from 2010 until 2014 were reviewed retrospectively. Patient characteristics and post-operative complications were obtained and analysed.

A total of 50 patients were included in this analysis. Sixteen were female, the median age was 73 years, and the median BMI was 26 kg/m2. Furthermore, the American Society of Anesthesiologists (ASA) scores were as follows: ASA 1 (28%), ASA 2 (60%), and ASA 3 (12%); their tumour-node-metastasis (TNM) staging was TNM: ≤ T2 (30%), T3 (50%), and T4 (20%); and 26% had received neoadjuvant radiotherapy, whereas 40% had received chemotherapy. A total of three patients (6%) developed a post-operative pelvic sepsis. The median length of post-operative hospitalisation was 9.5 days. Overall mortality was 4% (n = 50). The most frequent surgical complication to intersphincteric proctectomy was perineal wound infection, occurring in 20%.

This study suggests a reduction in the frequency of pelvic sepsis when intersphincteric proctectomy is performed in patients who undergo extended Hartmann's procedure. The frequency is, however, larger than that reported herein when the rectal stump is left long. Intersphincteric proctectomy should therefore primarily be reserved for low cancers with short rectal stumps.

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