Impact of Neoadjuvant Radiotherapy on Complications After Hartmann Procedure for Rectal Cancer.
BACKGROUND
The effects of neoadjuvant radiotherapy on healing of the rectal stump after a Hartmann procedure for rectal cancer are unknown.


OBJECTIVE
The purpose of this study was to analyze the impact of radiotherapy on postoperative complications after a Hartmann procedure for rectal cancer at a population level.


METHODS
This was a population-based observational study. Postoperative outcomes were compared between Hartmann procedures with and without radiotherapy. Risk factors for postoperative intra-abdominal abscess requiring reintervention, any reintervention, and 30-day or in-hospital mortality were analyzed using a multivariable model.


METHODS
The study included in-hospital registration for the Dutch Surgical Colorectal Audit.


METHODS
Patients with rectal cancer who underwent a Hartmann procedure (total or partial mesorectal excision with end colostomy) between 2009 and 2013 were included.


METHODS
Abdominal abscess requiring reintervention, any reintervention, and 30-day or in-hospital mortality were measured.


RESULTS
Of 1728 patients who underwent a Hartmann procedure for rectal cancer, 90.5% (n = 1563) received preoperative radiotherapy. Intra-abdominal abscess formation was significantly increased after radiotherapy (7.0% vs 3.0%; p = 0.049). Overall reinterventions (15.2% vs 15.4%; p = 0.90) and 30-day mortality (2.4% vs 3.5%; p = 0.48) were not associated with radiotherapy in univariable analysis. In multivariable analysis, radiotherapy was an independent predictor of postoperative intra-abdominal abscess requiring reintervention (OR, 2.81 (95% CI, 1.01-7.78)) but was not associated with overall reinterventions or mortality.


CONCLUSIONS
This study was limited by the data being self-reported. Case-mix adjustment was limited to information available in the data set, and no long-term outcome data were available.


CONCLUSIONS
Based on these population-based data, radiotherapy is independently associated with an increased risk of postoperative intra-abdominal abscess requiring reintervention after Hartmann procedure for rectal cancer. This finding is relevant for patient-tailored postoperative care but should probably not influence indication for radiotherapy, because it did not affect overall reinterventions and mortality (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A193).
1 Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands 2 Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands 3 Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands.
Frederik H W
FH
Jonker
Pieter J
PJ
Tanis
Peter-Paul L O
PP
Coene
Erwin
E
van der Harst
D018784:Abdominal Abscess / Q000453:epidemiology / Q000209:etiology; D000368:Aged; D003125:Colostomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D004210:Dissection / Q000379:methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D012007:Rectum / Q000473:pathology / Q000601:surgery; D018570:Risk Assessment