Actual role of Hartmann's resection in elective surgical treatment for carcinoma of rectum and sigmoid colon.
A consecutive series of 50 patients who underwent Hartmann's resection from 1967 to 1981 because of carcinoma of the rectum and sigmoid colon is reported upon herein. Indications for Hartmann's resection were palliation because of advanced disease (62 per cent of the patients), poor risk conditions and advanced age (24 per cent) and intraoperative complications or difficult primary anastomosis (14 per cent). The overall operative mortality and morbidity rates were 8 and 80 per cent, respectively--pelvic sepsis accounted for 37.5 per cent of the complications. The five year survival rate for patients with radical operations was 46 per cent. The choice of Hartmann's resection for patients with advanced disease was unfair because of the high postoperative morbidity and the discomfort of colostomy. The indications for intestinal resection without primary anastomosis because of general conditions or technical difficulties to perform the anastomosis are actually reduced by the improved perioperative care and by the confidence in using stapling guns. Hartmann's resection is still indicated in elderly patients, in instances of locally advanced tumors and when the primary anastomosis is judged to be unfeasible.
D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012306:Risk