What to do with the rectal stump during sphincter preserving rectal cancer resection with end colostomy: a...

Low Hartmann's resection (LHR) and intersphincteric abdominoperineal excision (iAPR) are both feasible options in the treatment of rectal cancer when restoration of bowel continuity is not desired. The aim of this study was to compare the incidence of pelvic abscess and associated need for re-intervention and readmission after LHR and iAPR.

From a snapshot research project in which all rectal cancer resections from 71 Dutch hospitals in 2011 were evaluated, patients who underwent LHR or iAPR were selected.

A total of 185 patients were included: 139 LHR and 46 iAPR. No differences in baseline characteristics were found except for more multivisceral resections in the iAPR group (22% vs 10%; P = 0.041). Pelvic abscesses were diagnosed in 17% of the LHR group after a median of 21 days (interquartile range 10-151 days), compared to 11% in the iAPR group (P = 0.352) after a median of 90 days (interquartile range 44-269 days; P = 0.102). All 28 patients with a pelvic abscess underwent at least one re-intervention. Four patients (9%) in the iAPR group and nine (7%) after LHR were readmitted because of a pelvic abscess over a median 39 months of follow-up.

This cross-sectional multicentre study suggests that cross-stapling and intersphincteric resection of the rectal stump, during non-restorative rectal cancer resection, are associated with an equal risk of pelvic abscess formation and have a similar need for re-intervention and readmission.