Hartmann's procedure versus intersphincteric abdominoperineal excision (HiP Study): a multicentre prospective cohort...

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Patient Outcomes

Background:

• Low rectal cancer surgery sometimes necessitates avoiding coloanal anastomosis due to patient frailty or poor function.
• Hartmann's procedure (HP) and intersphincteric abdominoperineal excision (IAPE) are alternative surgical approaches.
• Limited data exist comparing the safety of HP versus IAPE in this context.

Purpose of the Study:

• To compare the surgical complication rates between Hartmann's procedure (HP) and intersphincteric abdominoperineal excision (IAPE) in patients with low rectal cancer.
• To evaluate secondary outcomes including length of hospital stay, time to adjuvant therapy, and quality of life.

Main Methods:

• A multicentre, nonrandomized prospective cohort study involving 179 patients.
• Patients underwent either HP or IAPE between April 2016 and June 2019.
• Primary endpoint was the surgical complication rate; secondary endpoints included length of stay, time to adjuvant therapy, and 90-day quality of life.

Main Results:

• Overall complication rates were high and similar: 54% for HP and 52% for IAPE.
• Surgery-specific complication rates were also similar: 43% for HP and 48% for IAPE.
• HP had a higher pelvic abscess rate (11%), particularly with a palpable staple line (15% vs 2%). IAPE showed a higher incidence of serious medical complications (16% vs 5%) and reduced 90-day quality of life.

Conclusions:

• This study represents the largest prospective comparison of HP and IAPE for rectal cancer where primary anastomosis is not suitable.
• With comparable overall and surgery-specific complication rates, both HP and IAPE are supported as safe options for this patient group.
• Surgeons can consider either HP or IAPE based on patient-specific factors and potential risks, such as pelvic abscess with HP or medical complications with IAPE.