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Comparison of a low Hartmann's procedure with low colorectal anastomosis with and without defunctioning ileostomy after radiotherapy for rectal cancer: results from a national registry
Aim This study used a national registry to compare the outcome after a low Hartmann's procedure (LHP), defined as removal of most of the rectum to leave a short anorectal stump and an end colostomy, and low anterior resection (LA) with or without a diverting ileostomy (DI) in rectal cancer pati...
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| Published in: | Colorectal disease 2016-08, Vol.18 (8), p.785-792 |
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| container_title | Colorectal disease |
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| creator | Jonker, F. H. W. Tanis, P. J. Coene, P. P. L. O. Gietelink, L. van der Harst, E. |
| description | Aim
This study used a national registry to compare the outcome after a low Hartmann's procedure (LHP), defined as removal of most of the rectum to leave a short anorectal stump and an end colostomy, and low anterior resection (LA) with or without a diverting ileostomy (DI) in rectal cancer patients all of whom had received preoperative neoadjuvant radiotherapy (RT).
Method
Patients who underwent LHP or LA with or without DI for rectal cancer after RT between 2009 and 2013 were identified from the Dutch Surgical Colorectal Audit. The postoperative outcome was compared between the three groups and risk of complications, reoperation and mortality were analysed in a multivariable model.
Results
The study included 4288 patients were included, of whom 27.8% underwent LHP, 20.2% LA and 52.0% LA with DI. Thirty‐day mortality was higher after LHP (3.2% vs 1.3% and 1.3% for LA with or without DI, P |
| doi_str_mv | 10.1111/codi.13281 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1811875444</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1811875444</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4001-6a723201a8be9d8ea35044da50e62babf1f25dd77ebb30e46b3ef4b730a228743</originalsourceid><addsrcrecordid>eNqNkc1u1DAUhSMEoj-w4QGQdyCkFDtOYg87FGBaUVohilhaN_FNa0jswXY0zZvxeHgmbZcIb3zt-90j-5wse8HoCUvrbee0OWG8kOxRdsjKmueMM_l4Xxe5XDF6kB2F8JNSVgsmn2YHRS2krMXqMPvTuHED3gRniesJkMFtySn4OIK1rwLZeNehnjySrYk3-27nBuexizAQsBCiG10wYemD1fvCTZFo7CfbReOssdfEDOh27Eygj-iJB21cvEEPm5n0Ll0skh3YDv27dAzTEAPpvRvTsyzshFLf47UJ0c_Psic9DAGf3-3H2fdPH6-a0_z8cn3WvD_PuzL9N69BFLygDGSLKy0ReEXLUkNFsS5aaHvWF5XWQmDbcopl3XLsy1ZwCkUhRcmPs9eLbnLi94QhqtGEDocBLLopKCYZk6Iqy_9BqaxpvaI8oW8WtPMuBI-92ngzgp8Vo2oXqtqFqvahJvjlne7Ujqgf0PsUE8AWYJtcnv8hpZrLD2f3ovkyk9zE24cZ8L9ULbio1I-LtfrWrL98Lq6-qgv-F09CwO8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1808606903</pqid></control><display><type>article</type><title>Comparison of a low Hartmann's procedure with low colorectal anastomosis with and without defunctioning ileostomy after radiotherapy for rectal cancer: results from a national registry</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>Jonker, F. H. W. ; Tanis, P. J. ; Coene, P. P. L. O. ; Gietelink, L. ; van der Harst, E.</creator><creatorcontrib>Jonker, F. H. W. ; Tanis, P. J. ; Coene, P. P. L. O. ; Gietelink, L. ; van der Harst, E. ; Dutch Surgical Colorectal Audit Group ; Dutch Surgical Colorectal Audit Group</creatorcontrib><description>Aim
This study used a national registry to compare the outcome after a low Hartmann's procedure (LHP), defined as removal of most of the rectum to leave a short anorectal stump and an end colostomy, and low anterior resection (LA) with or without a diverting ileostomy (DI) in rectal cancer patients all of whom had received preoperative neoadjuvant radiotherapy (RT).
Method
Patients who underwent LHP or LA with or without DI for rectal cancer after RT between 2009 and 2013 were identified from the Dutch Surgical Colorectal Audit. The postoperative outcome was compared between the three groups and risk of complications, reoperation and mortality were analysed in a multivariable model.
Results
The study included 4288 patients were included, of whom 27.8% underwent LHP, 20.2% LA and 52.0% LA with DI. Thirty‐day mortality was higher after LHP (3.2% vs 1.3% and 1.3% for LA with or without DI, P < 0.001), but LHP was not an independent predictor of mortality in multivariable analysis. LHP and LA with DI were associated with a lower rate of abdominal infective complications (6.5% and 10.1% vs 16.2%, P < 0.001) and reoperation (7.3% and 8.1% vs 16.5%, P < 0.001). In multivariable analysis, LHP (OR 0.35, 95% CI 0.26–0.47) and LA with DI (OR 0.43, 95% CI 0.33–0.54) were associated with a lower risk of reoperation than LA alone. LHP was associated with a lower risk of any postoperative complication than LA with or without DI (OR 0.81, 95% CI 0.66–0.98).
Conclusion
LHP and LA with DI were associated with fewer infective complications and reoperations than LA alone. The rate of any complication was less after LHR than LA with or without DI.</description><identifier>ISSN: 1462-8910</identifier><identifier>EISSN: 1463-1318</identifier><identifier>DOI: 10.1111/codi.13281</identifier><identifier>PMID: 26788679</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Abdominal Abscess - epidemiology ; Aged ; Aged, 80 and over ; Anastomosis, Surgical - methods ; Anastomotic Leak - epidemiology ; Colon - surgery ; Digestive System Surgical Procedures - methods ; end-colostomy ; Female ; Hospital Mortality ; Humans ; Ileostomy - methods ; low anterior resection ; Male ; Middle Aged ; Multivariate Analysis ; Neoadjuvant Therapy ; Netherlands - epidemiology ; Postoperative Complications - epidemiology ; Radiotherapy ; Rectal cancer ; Rectal Neoplasms - pathology ; Rectal Neoplasms - surgery ; Rectum - surgery ; Registries ; Reoperation ; Retrospective Studies ; Surgical Wound Infection - epidemiology ; total mesorectal excision ; Treatment Outcome</subject><ispartof>Colorectal disease, 2016-08, Vol.18 (8), p.785-792</ispartof><rights>Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland</rights><rights>Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4001-6a723201a8be9d8ea35044da50e62babf1f25dd77ebb30e46b3ef4b730a228743</citedby><cites>FETCH-LOGICAL-c4001-6a723201a8be9d8ea35044da50e62babf1f25dd77ebb30e46b3ef4b730a228743</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26788679$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jonker, F. H. W.</creatorcontrib><creatorcontrib>Tanis, P. J.</creatorcontrib><creatorcontrib>Coene, P. P. L. O.</creatorcontrib><creatorcontrib>Gietelink, L.</creatorcontrib><creatorcontrib>van der Harst, E.</creatorcontrib><creatorcontrib>Dutch Surgical Colorectal Audit Group</creatorcontrib><creatorcontrib>Dutch Surgical Colorectal Audit Group</creatorcontrib><title>Comparison of a low Hartmann's procedure with low colorectal anastomosis with and without defunctioning ileostomy after radiotherapy for rectal cancer: results from a national registry</title><title>Colorectal disease</title><addtitle>Colorectal Dis</addtitle><description>Aim
This study used a national registry to compare the outcome after a low Hartmann's procedure (LHP), defined as removal of most of the rectum to leave a short anorectal stump and an end colostomy, and low anterior resection (LA) with or without a diverting ileostomy (DI) in rectal cancer patients all of whom had received preoperative neoadjuvant radiotherapy (RT).
Method
Patients who underwent LHP or LA with or without DI for rectal cancer after RT between 2009 and 2013 were identified from the Dutch Surgical Colorectal Audit. The postoperative outcome was compared between the three groups and risk of complications, reoperation and mortality were analysed in a multivariable model.
Results
The study included 4288 patients were included, of whom 27.8% underwent LHP, 20.2% LA and 52.0% LA with DI. Thirty‐day mortality was higher after LHP (3.2% vs 1.3% and 1.3% for LA with or without DI, P < 0.001), but LHP was not an independent predictor of mortality in multivariable analysis. LHP and LA with DI were associated with a lower rate of abdominal infective complications (6.5% and 10.1% vs 16.2%, P < 0.001) and reoperation (7.3% and 8.1% vs 16.5%, P < 0.001). In multivariable analysis, LHP (OR 0.35, 95% CI 0.26–0.47) and LA with DI (OR 0.43, 95% CI 0.33–0.54) were associated with a lower risk of reoperation than LA alone. LHP was associated with a lower risk of any postoperative complication than LA with or without DI (OR 0.81, 95% CI 0.66–0.98).
Conclusion
LHP and LA with DI were associated with fewer infective complications and reoperations than LA alone. The rate of any complication was less after LHR than LA with or without DI.</description><subject>Abdominal Abscess - epidemiology</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anastomosis, Surgical - methods</subject><subject>Anastomotic Leak - epidemiology</subject><subject>Colon - surgery</subject><subject>Digestive System Surgical Procedures - methods</subject><subject>end-colostomy</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Ileostomy - methods</subject><subject>low anterior resection</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neoadjuvant Therapy</subject><subject>Netherlands - epidemiology</subject><subject>Postoperative Complications - epidemiology</subject><subject>Radiotherapy</subject><subject>Rectal cancer</subject><subject>Rectal Neoplasms - pathology</subject><subject>Rectal Neoplasms - surgery</subject><subject>Rectum - surgery</subject><subject>Registries</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Surgical Wound Infection - epidemiology</subject><subject>total mesorectal excision</subject><subject>Treatment Outcome</subject><issn>1462-8910</issn><issn>1463-1318</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNqNkc1u1DAUhSMEoj-w4QGQdyCkFDtOYg87FGBaUVohilhaN_FNa0jswXY0zZvxeHgmbZcIb3zt-90j-5wse8HoCUvrbee0OWG8kOxRdsjKmueMM_l4Xxe5XDF6kB2F8JNSVgsmn2YHRS2krMXqMPvTuHED3gRniesJkMFtySn4OIK1rwLZeNehnjySrYk3-27nBuexizAQsBCiG10wYemD1fvCTZFo7CfbReOssdfEDOh27Eygj-iJB21cvEEPm5n0Ll0skh3YDv27dAzTEAPpvRvTsyzshFLf47UJ0c_Psic9DAGf3-3H2fdPH6-a0_z8cn3WvD_PuzL9N69BFLygDGSLKy0ReEXLUkNFsS5aaHvWF5XWQmDbcopl3XLsy1ZwCkUhRcmPs9eLbnLi94QhqtGEDocBLLopKCYZk6Iqy_9BqaxpvaI8oW8WtPMuBI-92ngzgp8Vo2oXqtqFqvahJvjlne7Ujqgf0PsUE8AWYJtcnv8hpZrLD2f3ovkyk9zE24cZ8L9ULbio1I-LtfrWrL98Lq6-qgv-F09CwO8</recordid><startdate>201608</startdate><enddate>201608</enddate><creator>Jonker, F. H. W.</creator><creator>Tanis, P. J.</creator><creator>Coene, P. P. L. O.</creator><creator>Gietelink, L.</creator><creator>van der Harst, E.</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7T5</scope><scope>H94</scope></search><sort><creationdate>201608</creationdate><title>Comparison of a low Hartmann's procedure with low colorectal anastomosis with and without defunctioning ileostomy after radiotherapy for rectal cancer: results from a national registry</title><author>Jonker, F. H. W. ; Tanis, P. J. ; Coene, P. P. L. O. ; Gietelink, L. ; van der Harst, E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4001-6a723201a8be9d8ea35044da50e62babf1f25dd77ebb30e46b3ef4b730a228743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Abdominal Abscess - epidemiology</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anastomosis, Surgical - methods</topic><topic>Anastomotic Leak - epidemiology</topic><topic>Colon - surgery</topic><topic>Digestive System Surgical Procedures - methods</topic><topic>end-colostomy</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Ileostomy - methods</topic><topic>low anterior resection</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neoadjuvant Therapy</topic><topic>Netherlands - epidemiology</topic><topic>Postoperative Complications - epidemiology</topic><topic>Radiotherapy</topic><topic>Rectal cancer</topic><topic>Rectal Neoplasms - pathology</topic><topic>Rectal Neoplasms - surgery</topic><topic>Rectum - surgery</topic><topic>Registries</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Surgical Wound Infection - epidemiology</topic><topic>total mesorectal excision</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jonker, F. H. W.</creatorcontrib><creatorcontrib>Tanis, P. J.</creatorcontrib><creatorcontrib>Coene, P. P. L. O.</creatorcontrib><creatorcontrib>Gietelink, L.</creatorcontrib><creatorcontrib>van der Harst, E.</creatorcontrib><creatorcontrib>Dutch Surgical Colorectal Audit Group</creatorcontrib><creatorcontrib>Dutch Surgical Colorectal Audit Group</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>Colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jonker, F. H. W.</au><au>Tanis, P. J.</au><au>Coene, P. P. L. O.</au><au>Gietelink, L.</au><au>van der Harst, E.</au><aucorp>Dutch Surgical Colorectal Audit Group</aucorp><aucorp>Dutch Surgical Colorectal Audit Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of a low Hartmann's procedure with low colorectal anastomosis with and without defunctioning ileostomy after radiotherapy for rectal cancer: results from a national registry</atitle><jtitle>Colorectal disease</jtitle><addtitle>Colorectal Dis</addtitle><date>2016-08</date><risdate>2016</risdate><volume>18</volume><issue>8</issue><spage>785</spage><epage>792</epage><pages>785-792</pages><issn>1462-8910</issn><eissn>1463-1318</eissn><abstract>Aim
This study used a national registry to compare the outcome after a low Hartmann's procedure (LHP), defined as removal of most of the rectum to leave a short anorectal stump and an end colostomy, and low anterior resection (LA) with or without a diverting ileostomy (DI) in rectal cancer patients all of whom had received preoperative neoadjuvant radiotherapy (RT).
Method
Patients who underwent LHP or LA with or without DI for rectal cancer after RT between 2009 and 2013 were identified from the Dutch Surgical Colorectal Audit. The postoperative outcome was compared between the three groups and risk of complications, reoperation and mortality were analysed in a multivariable model.
Results
The study included 4288 patients were included, of whom 27.8% underwent LHP, 20.2% LA and 52.0% LA with DI. Thirty‐day mortality was higher after LHP (3.2% vs 1.3% and 1.3% for LA with or without DI, P < 0.001), but LHP was not an independent predictor of mortality in multivariable analysis. LHP and LA with DI were associated with a lower rate of abdominal infective complications (6.5% and 10.1% vs 16.2%, P < 0.001) and reoperation (7.3% and 8.1% vs 16.5%, P < 0.001). In multivariable analysis, LHP (OR 0.35, 95% CI 0.26–0.47) and LA with DI (OR 0.43, 95% CI 0.33–0.54) were associated with a lower risk of reoperation than LA alone. LHP was associated with a lower risk of any postoperative complication than LA with or without DI (OR 0.81, 95% CI 0.66–0.98).
Conclusion
LHP and LA with DI were associated with fewer infective complications and reoperations than LA alone. The rate of any complication was less after LHR than LA with or without DI.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>26788679</pmid><doi>10.1111/codi.13281</doi><tpages>8</tpages></addata></record> |
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| ispartof | Colorectal disease, 2016-08, Vol.18 (8), p.785-792 |
| issn | 1462-8910 1463-1318 |
| language | eng |
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| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Abdominal Abscess - epidemiology Aged Aged, 80 and over Anastomosis, Surgical - methods Anastomotic Leak - epidemiology Colon - surgery Digestive System Surgical Procedures - methods end-colostomy Female Hospital Mortality Humans Ileostomy - methods low anterior resection Male Middle Aged Multivariate Analysis Neoadjuvant Therapy Netherlands - epidemiology Postoperative Complications - epidemiology Radiotherapy Rectal cancer Rectal Neoplasms - pathology Rectal Neoplasms - surgery Rectum - surgery Registries Reoperation Retrospective Studies Surgical Wound Infection - epidemiology total mesorectal excision Treatment Outcome |
| title | Comparison of a low Hartmann's procedure with low colorectal anastomosis with and without defunctioning ileostomy after radiotherapy for rectal cancer: results from a national registry |
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