title: Hartmann's procedure vs loop colostomy in the treatment of obstructive rectosigmoid cancer.
abstract: BACKGROUND
  Colorectal carcinoma is the most common malignant gastrointestinal tumour. There is still a considerable controversy when it comes to urgent surgical treatment of obstructive carcinoma of the left colon and rectum.
  
  
  METHODS
  Seventy-five patients from the randomized trial were followed up. This study was designed as a stratified randomized trial with four stratums according to age and ASA score (older/younger than 60 years and ASA score <>3). Each of the four groups is then divided into two sub-groups according to the operating technique: loop colostomy or Hartmann's procedure.
  
  
  RESULTS
  There were no difference found in hospitalization among the groups (loop colostomy vs. Hartmann's procedure) in the same stratus (P = 0.3192, P = 0.5760, P = 0.9023 respectively), except in the case of doing reconstructive procedure after loop colostomy (P = 0.0049) in the fourth stratum (patients younger than 60 years with ASA score lower than 3). Type of operation had no influence over the blood test values observed on admittance and during hospitalization (P = 0.319, P = 0.871, P = 0.7, P = 0.843, P = 0.52 respectively for the blood values). In terms of surgical and non-surgical complications it has been shown that there is no statistically significant difference between patients treated by two methods. Age, gender, ASA score, type of operation and surgical complications were not singled out as a risk factor for fatal outcome (P = 0.199, P = 0.155, P = 0.764, P = 0.452 and P = 0.724 respectively). The only factors that are singled out as a risk factor for death are the emergence of non-surgical complications and angina pectoris (P = 0.006, P = 0.001).
  
  
  CONCLUSIONS
  There is no difference in surgical treatment of large bowel obstruction caused by rectosigmoid carcinoma. Neither of those two methods showed significant advantage in treatment of large bowel obstruction caused by rectosigmoid cancer.
authors.affiliation: University of Belgrade, Belgrade, Serbia ; Clinic for Emergency Surgery, Emergency center, Clinical centre of Serbia, Belgrade, Serbia.
authors.forename: Slobodan
authors.initials: S
authors.lastname: Krstic
authors.affiliation: Clinic for Emergency Surgery, Emergency center, Clinical centre of Serbia, Belgrade, Serbia.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Resanovic
authors.affiliation: University of Belgrade, Belgrade, Serbia ; Clinic for Gastroenterology, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Tamara
authors.initials: T
authors.lastname: Alempijevic
authors.affiliation: Surgery Department, Medical Center "Bezanijska kosa", Belgrade, Serbia.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Resanovic
authors.affiliation: University of Belgrade, Belgrade, Serbia ; Clinic for Emergency Surgery, Emergency center, Clinical centre of Serbia, Belgrade, Serbia.
authors.forename: Ana
authors.initials: A
authors.lastname: Sijacki
authors.affiliation: University of Belgrade, Belgrade, Serbia ; Clinic for Emergency Surgery, Emergency center, Clinical centre of Serbia, Belgrade, Serbia.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Djukic
authors.affiliation: University of Belgrade, Belgrade, Serbia ; Clinic for Emergency Surgery, Emergency center, Clinical centre of Serbia, Belgrade, Serbia.
authors.forename: Zlatibor
authors.initials: Z
authors.lastname: Loncar
authors.affiliation: University of Belgrade, Belgrade, Serbia ; Clinic for Emergency Surgery, Emergency center, Clinical centre of Serbia, Belgrade, Serbia.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Karamarkovic
keywords: ASA score; Hartmann’s procedure; Loop colostomy; Obstructive rectosigmoid cancer