title: Hartmann's procedure in rectal cancer: a population-based study of postoperative complications.
abstract: OBJECTIVE
  Hartmann's procedure for rectal cancer patients is increasingly performed but few studies have reported the postoperative outcome. The purpose was to report postoperative complications and analyse risk factors in rectal cancer patients operated with Hartmann's procedure. To describe the selection and postoperative complication patterns, all bowel-resected rectal cancer patients were included.
  
  
  METHODS
  Population-based data were from the county of Västmanland, Sweden. All rectal cancer patients operated with an elective bowel resection between 1996 and 2012 were included. Demographics and postoperative complications were prospectively registered and data retrospectively analysed.
  
  
  RESULTS
  Of the 624 patients included, 396 (64%) were operated with an anterior resection, 159 (25%) with an abdominoperineal excision and 69 (11%) a Hartmann's procedure of which 90% were low Hartmann's. Patients operated with a Hartmann's procedure were significantly older, had higher ASA-score, poorer WHO performance score and lower serum albumin levels. Operative time for Hartmann's procedure was a median of 49 and 99 min shorter than after anterior resection and abdominoperineal excision, respectively, and entailed less bleeding. Complications related to the pelvic and perineal dissections were more common after abdominoperineal excision compared with anterior resection and Hartmann's procedure (32 vs. 9 and 13%, p < 0.001).
  
  
  CONCLUSIONS
  Few rectal cancer patients, operated with Hartmann's procedure, developed pelvic complications despite a higher age, more co-morbidities, metastases in different localities and functional inferiority when compared with the patients operated with anterior resection or abdominoperineal excision. Hartmann's procedure is a valid alternative procedure in the old and frail rectal cancer patient.
authors.affiliation: Colorectal Unit, Department of Surgery and Centre for Clinical Research of Uppsala University, Västmanland's Hospital Västerås, 72189, Västerås, Sweden, ingvar.sverrisson@ltv.se.
authors.forename: Ingvar
authors.initials: I
authors.lastname: Sverrisson
authors.forename: Maziar
authors.initials: M
authors.lastname: Nikberg
authors.forename: Abbas
authors.initials: A
authors.lastname: Chabok
authors.forename: Kenneth
authors.initials: K
authors.lastname: Smedh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D012004:Rectal Neoplasms / Q000601:surgery*; D013548:Sweden / Q000453:epidemiology