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2025
article
Oncological outcomes of planned and unplanned low Hartmann’s procedure and restorative low anterior resection for rectal cancer: a population-based cross-sectional study
Eline G M van Geffen, Floris S. Verheij, Sanne-Marije J.A. Hazen, Tania C. Sluckin, Esther C. J. Consten, J-W T Dekker, Joost Nederend, Koen Peeters, Johannes H. W. de Wilt, Susan van Dieren, Roel Hompes, Jurriaan B. Tuynman, Corrie A.M. Marijnen, Pieter J. Tanis, M Kusters, A. G. J Aalbers, S M Van Aalten, F.J. Amelung, M. Ankersmit, I. Antonisse, J. F. Ashruf, T.S. Aukema, H. Avenarius, R. R. Bahadoer, F. C. H. Bakers, I.S. Bakker, F. Bangert, R. M. Barendse, H. M. D. Beekhuis, G. L. Beets, R Beets-Tan, W. A. Bemelman, M. Berbée, S. H. de Bie, R. H. C. Bisschops, Blok Rj, van Bockel Lw, A. H. Boer, F. C. Den Boer, E.-J.G. Boerma, L. S. F. Boogerd, J. Borstlap, W.A.A. Borstlap, J. E. Bouwman, S. J. Braak, M.N.G.J.A. Braat, J. Bradshaw, Brandsma Ag, V. van Breest Smallenburg, W. T. van den Broek, S. W. van der Burg, J. W. A. Burger, T.A. Burghgraef, D. W. G ten Cate, H.M. Ceha, J. S. Cnossen, R. R. J. Coebergh van den Braak, M. Corver, Crolla Rm, S. Curutchet, A. W. Daniëls-Gooszen, P. H. P. Davids, E.N. Dekker, J.W.T. Dekker, A Demirkiran, T. Derksen, A. L. Diederik, A. M. Dinaux, K. Dogan, I. M. van Dop, Greve Kl, H M Duijsens, Dunker Ms, J. Duyck, E. B. van Duyn, L. S. E. van Egdom, B. Eijlers, Y. El-Massoudi, S. Van Elderen, A. M. L. H. Emmen, M. Engelbrecht, A. C. van Erp, J. A. Essen, H.F.J. Fabry, T A Fassaert, E. A. Feitsma, S. S. Feshtali, B. Frietman, E. J. B. Furnee, A. M. van Geel, E D Geijsen, A. A. W. van Geloven, M. F. Gerhards, H. Gielkens, R Gils, L. Goense, M.J.P.M. Govaert, W M U Van Grevenstein, E. J. de Groof, I JM de Groot, R.J. de Haas, N. A. G. Hakkenbrak, M. D. den Hartogh, V. Heesink, J.T. Heikens, E.M. Hendriksen, S. Van der Hoek, E.J.R.J. van der Hoeven, C. Hoff, A. Hogewoning, C.R.C. Hogewoning, S. Hoogendoorn, F. van Hoorn, K. Horsthuis, R. L. van der Hul, R. van Hulst, F. Imani, B. Inberg, M. P. W. Intven, P. Janssen, C. E. J. de Jong, J. Jonkers, D. Jou-Valencia, B. Keizers, S H J Ketelaers, E. Knöps, S. van Koeverden, S. de Kok, S Kolderman, F. I. de Korte, Kortekaas Rt, J. C. Korving, I M Koster, J. Krdzalic, P. Krielen, L. F. Kroese, E.J.T. Krul, D. H. H. Lahuis, B. Lamme, A A L Van Landeghem, J. W. A. Leijtens, M. M. Leseman-Hoogenboom, M. S. de Lijster, C. A. M. Marijnen, Mandy Marsman, M.H. Martens, I. Masselink, W van der Meij, P. Meijnen, J. Melenhorst, D. J. L. de Mey, J. Moelker-Galuzina, L. Morsink, E. J. Mulder, K. Müller, G.D. Musters, P. A. Neijenhuis, L.C.F. De Nes, M. Nielen, J. B. J. van den Nieuwboer, J. F. Nieuwenhuis, J. Nonner, Noordman Bj, S Nordkamp, P. B. Olthof, S.J. Oosterling, D. Ootes, V. Oppedijk, P. Ott, I. Paulusma, ITA Pereboom, J. Peringa, Z. Pironet, J. D. J. Plate, F. Polat, I. G. M. Poodt, L. A. E. Posma, J.F. Prette, B.B. Pultrum, S. M. Qaderi, J. M. van Rees, R.J. Renger, A G Rombouts, L. J. Roosen, E. A. Roskott-ten Brinke, J. Rothbarth, D. B. Rouw, T Rozema, H. J. T. Rutten, M. E. van der Sande, B.E. Schaafsma, R A Schasfoort, M M Scheurkogel, A.P. Schouten van der Velden, W. H. Schreurs, P.M.E. Schuivens, C Sietses, P.C.G. Simons, Slob Mj, G D Slooter, M. van der Sluis, B.P. Smalbroek, A. B. Smits, E. J. Spillenaar‐Bilgen, P. H. Spruit, Stam Ta, J. Stoker, A K Talsma, S. J. D. Temmink, G Y Mireille, J.A.W. Tielbeek, A. A. J. M. van Tilborg, F. van Tilborg, D. van Trier, M. J. M. van der Valk, I J S M L Vanhooymissen, G. Boudewijn, C. Vasbinder, C. J. Veeken, L.A. Velema, A. W. H. van de Ven, E. G. G. Verdaasdonk, W. M. Verduin, T. Verhagen, P.M. Verheijen, M. Vermaas, A E Verrijssen, A. V. D. Verschuur, H. Verwoerd-van Schaik, R.F.A. Vliegen, S. Voets, F. Jeroen Vogelaar, C. L. A. Vogelij, J. Vos-Westerman, M. de Vries, Vroemen Jp, B. S. T. van Vugt, J.A. Wegdam, B.J. van Wely, M Westerterp, P.P. van Westerveld, H. L. van Westreenen, A G Wijma, B. W. K. de Wit, F. Wit, K. Woensdregt, V. van Woerden, F Wolf, S. van der Wolk, J. M. Wybenga, E. S. van der Zaag, B. Zamaray, H.J.A. Zandvoort, D S Zee, A. P. Zeilstra, K. J. Zheng, D. D. E. Zimmerman, M. Zorgdrager
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14Institutions déclarées
1Pays d’affiliation déclarés
Rattachement africain : nl.
Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
BACKGROUND: In the Netherlands, approximately 15% of patients with rectal cancer undergo a low Hartmann's procedure (low-HP). This is often preoperatively planned to avoid poor functional outcome or complications, but might be unplanned as a result of intraoperative difficulties. Low-HPs seem to be associated with worse oncological outcomes. METHODS: All patients who underwent either restorative low anterior resection (rLAR), planned low-HP, or unplanned low-HP for primary rectal cancer in 2016 were included from a nationwide cohort. Main outcomes were 4-year local recurrence (LR) rate and disease-free survival (DFS). RESULTS: Of 2043 patients, 1704 underwent rLAR (83.4%), 253 planned low-HP (12.4%), and 86 unplanned low-HP (4.2%). Among intended rLAR patients (n = 1790), independent risk factors for unplanned low-HP were older age, higher body mass index (BMI), higher American Society of Anesthesiologists (ASA) score, and more distal tumor location. Oncological outcomes after low-HPs were worse than after rLARs (LR 13.7% vs 5.6%, DFS 54.7% vs 71.8%, both p < 0.001), but similar for unplanned and planned low-HP. In multivariable analysis, unplanned and planned low-HP were not associated with LR or DFS, but R1 resection was (HR 6.6 (4.1-10.6), HR 3.0 (2.2-4.0), respectively). In R1 resections, the distal margin was more often involved after low-HP (70.0% vs 28.6%, p = 0.013) compared to rLAR. CONCLUSION: Poor outcomes in univariable analysis after low-HP appear to be associated with more challenging procedures and increased risk of involved resection margin rather than the low-HP itself. In case of expected difficulties, an extralevator abdominoperineal excision or referral to an expert center might be an alternative to improve resection margins. TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT05539417, retrospectively registered on September 16, 2022.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Oncological outcomes of planned and unplanned low Hartmann’s procedure and restorative low anterior resection for rectal cancer: a population-based cross-sectional study
- Date Crossref
- 23/11/2025
- Éditeur
- Springer Science and Business Media LLC
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
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Les sujets associés
Diverticular Disease and ComplicationsColorectal Cancer Surgical TreatmentsColorectal Cancer Screening and Detection