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Oncological outcome following Hartmann's procedure compared with anterior resection and abdominoperineal resection for rectal cancer—The type of procedure does not influence local recurrence or distant metastasis : A population-based study

Mariusdottir, Elin LU ; Jörgren, Fredrik LU ; Lydrup, Marie Louise LU and Buchwald, Pamela LU (2024) In Colorectal Disease 26(10). p.1822-1830
Abstract

Aim: The type of surgical procedure used in rectal cancer treatment may affect cancer recurrence. The aim of this study was to determine whether the type of procedure influences oncological outcomes in rectal cancer surgery. Method: We gathered data from the Swedish Colorectal Cancer Registry regarding patients with TNM Stage I–III rectal cancer who underwent R0/R1 surgery from 2013 to 2017. The outcomes after Hartmann's procedure (HP), anterior resection (AR) and abdominoperineal resection (APR) were compared, and a multivariable Cox regression analysis was performed. The primary outcome of the study was the local recurrence rate. The secondary outcomes were distant metastasis, disease-free survival and overall survival at 5 years as... (More)

Aim: The type of surgical procedure used in rectal cancer treatment may affect cancer recurrence. The aim of this study was to determine whether the type of procedure influences oncological outcomes in rectal cancer surgery. Method: We gathered data from the Swedish Colorectal Cancer Registry regarding patients with TNM Stage I–III rectal cancer who underwent R0/R1 surgery from 2013 to 2017. The outcomes after Hartmann's procedure (HP), anterior resection (AR) and abdominoperineal resection (APR) were compared, and a multivariable Cox regression analysis was performed. The primary outcome of the study was the local recurrence rate. The secondary outcomes were distant metastasis, disease-free survival and overall survival at 5 years as well as risk factors for local recurrence. Results: A total of 4741 patients were included in the study: 614 underwent HP, 3075 underwent AR and 1052 underwent APR. Multivariable Cox regression revealed no difference in local recurrence, distant metastasis or disease-free survival. Overall survival was higher following AR (OR 0.62, CI 0.54–0.72). Risk factors for local recurrence were intraoperative bowel perforation (OR 2.41, CI 1.33–4.40), a pT4 tumour (OR 1.93, CI 1.11–3.4) and a positive circumferential resection margin (OR 5.62, CI 3.28–9.61). Conclusions: This nationwide study showed that the type of procedure did not affect the local recurrence rate or distant metastasis. In patients who are unfit for restorative surgery, HP is a viable alternative with oncological outcomes similar to those of APR.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Hartmann's procedure, local recurrence, oncological outcome, rectal cancer
in
Colorectal Disease
volume
26
issue
10
pages
9 pages
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:39245864
  • scopus:85203332774
ISSN
1462-8910
DOI
10.1111/codi.17163
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2024 Association of Coloproctology of Great Britain and Ireland.
id
80751cd6-9560-49cc-ac3a-2fbda27b05dc
date added to LUP
2024-12-09 15:46:50
date last changed
2025-07-08 08:35:22
@article{80751cd6-9560-49cc-ac3a-2fbda27b05dc,
  abstract     = {{<p>Aim: The type of surgical procedure used in rectal cancer treatment may affect cancer recurrence. The aim of this study was to determine whether the type of procedure influences oncological outcomes in rectal cancer surgery. Method: We gathered data from the Swedish Colorectal Cancer Registry regarding patients with TNM Stage I–III rectal cancer who underwent R0/R1 surgery from 2013 to 2017. The outcomes after Hartmann's procedure (HP), anterior resection (AR) and abdominoperineal resection (APR) were compared, and a multivariable Cox regression analysis was performed. The primary outcome of the study was the local recurrence rate. The secondary outcomes were distant metastasis, disease-free survival and overall survival at 5 years as well as risk factors for local recurrence. Results: A total of 4741 patients were included in the study: 614 underwent HP, 3075 underwent AR and 1052 underwent APR. Multivariable Cox regression revealed no difference in local recurrence, distant metastasis or disease-free survival. Overall survival was higher following AR (OR 0.62, CI 0.54–0.72). Risk factors for local recurrence were intraoperative bowel perforation (OR 2.41, CI 1.33–4.40), a pT4 tumour (OR 1.93, CI 1.11–3.4) and a positive circumferential resection margin (OR 5.62, CI 3.28–9.61). Conclusions: This nationwide study showed that the type of procedure did not affect the local recurrence rate or distant metastasis. In patients who are unfit for restorative surgery, HP is a viable alternative with oncological outcomes similar to those of APR.</p>}},
  author       = {{Mariusdottir, Elin and Jörgren, Fredrik and Lydrup, Marie Louise and Buchwald, Pamela}},
  issn         = {{1462-8910}},
  keywords     = {{Hartmann's procedure; local recurrence; oncological outcome; rectal cancer}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{1822--1830}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Colorectal Disease}},
  title        = {{Oncological outcome following Hartmann's procedure compared with anterior resection and abdominoperineal resection for rectal cancer—The type of procedure does not influence local recurrence or distant metastasis : A population-based study}},
  url          = {{http://dx.doi.org/10.1111/codi.17163}},
  doi          = {{10.1111/codi.17163}},
  volume       = {{26}},
  year         = {{2024}},
}