title: Low rectal cancer: abdominoperineal resection or low Hartmann resection? A postoperative outcome analysis.
abstract: BACKGROUND
  In distal rectum cancers, when the sphincters are not affected and it is not possible to perform a coloanal anastomosis because of the presence of comorbidities or the advanced age of the patient, a low Hartmann resection with total mesorectal excision can be performed. Low Hartmann resection is usually considered to be a shorter procedure and to have an inferior morbidity compared with abdominoperineal resection of the rectum.
  
  
  OBJECTIVE
  This study aimed to compare the postoperative outcome of a series of patients with low rectal cancer who have undergone either low Hartmann resection or abdominoperineal resection.
  
  
  METHODS
  This study is a retrospective analysis of data collected in a prospective database.
  
  
  METHODS
  This study was conducted in a specialized Colorectal Unit, Department of Surgery, of a tertiary teaching hospital.
  
  
  METHODS
  Patients who underwent low Hartmann or abdominoperineal resection for rectal cancer between 1996 and 2009 at our specialized Colorectal Unit were considered.
  
  
  METHODS
  The main interventions were low Hartmann resection vs abdominoperineal resection.
  
  
  METHODS
  The main outcome measures were 60-day morbidity and mortality.
  
  
  RESULTS
  The pelvic abscess rate was 12.2% in patients who underwent low Hartmann resection and 3.0% in those who underwent abdominoperineal resection (P = .02). The reoperation rate was 14.6% in the Hartmann group and 3.8% in the abdominoperineal group (P = .013). The rehospitalization rates in the Hartmann and abdominoperineal groups were 7.3% and 0.7% (P = .015). No differences were found in the other variables analyzed. At multivariate analysis, the surgical technique performed was the only independent risk factor for pelvic abscess development, readmission, and reoperation.
  
  
  CONCLUSIONS
  : This study was limited by its retrospective nature.
  
  
  CONCLUSIONS
  In our series, low Hartmann resection was associated with higher pelvic abscess, reoperation, and readmission rates. These findings suggest that in patients with rectal cancer without sphincter infiltration and who are unsuitable for coloanal anastomosis, abdominoperineal resection should be a valid alternative to low Hartmann resection.
authors: Department of General Surgery, Coloproctology Unit, Hospital Clínico Universitario, University of Valencia, Valencia, Spain.
authors: José Luis
authors: JL
authors: Molina Rodríguez
authors: Blas
authors: B
authors: Flor-Lorente
authors: Matteo
authors: M
authors: Frasson
authors: Stephanie
authors: S
authors: García-Botello
authors: Pedro
authors: P
authors: Esclapez
authors: Alejandro
authors: A
authors: Espí
authors: Eduardo
authors: E
authors: García-Granero
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult