title: [The place of Hartmann's resections for some advanced distal rectal cancers].
abstract: ADRC involves the adjacent structures and systems in the minor pelvis and the achievement of the importent for the prognosis Ro resection is technically challenging. The main problem is to obtain the circumferential clearance and it could require a hysterectomy, vaginal, ureteral, bladder resection or exsenteration. The restoration of the urinary tract integrity is obligatory, but the complications are common if the gut passage is restored too. An additional indication for a two-stage operation is the high rate of LR for ADRC.
  
  
  METHODS
  14 ADRC with T4 lesions are treated radically with Hartmann's procedures. Fore interventions were with left ureter resections, another one was complete both ureters resection and their implantation in the bladder. The posterior minor pelvis eviscerations were 8.
  
  
  RESULTS
  The urine leakage was found in three cases. The complications were treated successfully with an active aspiration through the urethral catheter for 10-15 days. No complications were observed after pelvic eviscerations, but LR were developed after 2 of them. The one was founded after a year and another--two years from the restitution of the gut's tract. There was one LR after Hartmann procedure with ureter resection. No operative mortality was registered.
  
  
  CONCLUSIONS
  The Hartmann's operations are indicated for some ADRC when preservations of the sphincters is possible. An bloc of the parts from urinary system requires restoration of their integrity. The simultaneous gut restitution increases the risk for complications. The high LR rate by ADRC and the adjuvant radiotherapy are also an indication for a Hartmann's procedure. The most of the LR are developed till end of the first year from the operation and the reasonable term for gut restoration is at same time.
authors.forename: N
authors.initials: N
authors.lastname: Damianov
mesh_terms: D001003:Anal Canal / Q000601:surgery; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D010388:Pelvis / Q000601:surgery; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D014513:Ureter / Q000601:surgery; D001743:Urinary Bladder / Q000601:surgery