Results of emergency Hartmann's operation for obstructive or perforated left-sided colorectal cancer

• Published in: World journal of surgical oncology 2008-08, Vol.6 (1), p.90-90, Article 90
• Main Authors: Charbonnet, Pierre, Gervaz, Pascal, Andres, Axel, Bucher, Pascal, Konrad, Béatrice, Morel, Philippe
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Care and treatment; Colectomy; Colorectal cancer; Colorectal Neoplasms - mortality; Colorectal Neoplasms - surgery; Colostomy; Diagnosis; Emergency Treatment; Excision (Surgery); Female; Humans; Intestinal Obstruction - mortality; Intestinal Obstruction - surgery; Intestinal Perforation - mortality; Intestinal Perforation - surgery; Male; Methods; Middle Aged; Physiological aspects; Retrospective Studies; Survival Analysis
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/1477-7819-6-90

Up to 15% of colorectal cancer (CRC) patients present with obstructive or perforated tumours, and require emergency surgery. The Hartmann's procedure (HP) provides the opportunity to achieve a potentially curative (R0) resection, while minimizing surgical trauma in poor-risk patients. The aim of this study was to assess the surgical (operative mortality), and oncological (long-term survival after curative resection) results of emergency HP for obstructive or perforated left-sided CRC. A retrospective review of 50 patients who underwent emergency HP for perforated/obstructive CRC in our institution between 1995 and 2006. Median age of patients was 75 (range 22-95) years and the indications for HP were obstruction (32) and perforation (18 patients). Operative mortality and morbidity were 8% and 26% respectively. 35 patients (70%) were operated with a curative intent; in this group, overall 1-, 3- and 5-year survival rates were 80%, 54% and 40%. In univariate analysis, the presence of lymph node metastases was associated with poor 5-year survival (62% [Stage II] vs. 27% [Stage III], log-rank test, p = 0.02). Eleven patients (22%) had their operation reversed with a median delay of 225 (range 94-390) days. In this subgroup, two patients died from distant metastases, but there were no instances of loco-regional recurrence. Hartmann's operation remains a good option to palliate symptoms in 30% of patients with left-sided CRC who are not candidates to a curative resection. For those who have a curative resection, the oncological outcome is acceptable, especially stage II patients, who appear to benefit the most from this surgical strategy.