HARTMANNS PROCEDURE VS. ABDOMINOPERINEAL RESECTION FOR PALLIATION OF ADVANCED LOW RECTAL-CANCER

In managing advanced low rectal adenocarcinomas in medically fit patie nts, surgical resection offers the best palliation. Tenesmus, bleeding per rectum, sacral pain, and sciatic pain are common complaints, whic h are not relieved by radiotherapy or fulguration. The most appropriat e resection, however, remains controversial. Abdominoperineal resectio n is faster and simpler to perform but leaves behind a perineal wound with associated complications. Hartmann's procedure requires adequate mobilization below the tumor and may be technically more demanding but avoids a perineal wound. Therefore, an analysis of outcome in patient s treated by Hartmann's procedure vs. abdominoperineal resection was m ade. METHOD: Fifty-four symptomatic patients with advanced rectal aden ocarcinoma arising within a median of 5 (range, 4-8) cm from the anal verge treated between June 1989 and October 1995 were studied. Twenty- eight patients (17 males; mean age, 67.6 +/- 10.3 years) had Hartmann' s procedure, and 26 patients (12 females; mean age, 68.8 +/- 8.3 years ) were treated by abdominoperineal resection. Mean followup was 23.5 m onths (+/-17.5) and 18.6 months (+/-12.9) in Hartmann's procedure and abdominoperineal groups, respectively. RESULTS: Mean operative time wa s 138.4 +/- 26.7 minutes for Hartmann's procedure group and 124.6 +/- 27.1 minutes for the abdominoperineal resection group (P > 0.05; not s ignificant). Postoperatively, Hartmann's procedure group started oral intake at a mean of 2.3 days, and stomas were functioning at a mean of 3.1 days compared with 2.6 days for oral intake and 3 days for stoma functioning in the abdominoperineal resection group. Hartmann's proced ure group was ambulant after a mean of 2.4 days vs a mean of 3.2 days in the abdominoperineal resection group. Postoperative abdominal wound infection occurred in 18 and 19 percent, respectively, in Hartmann's procedure and abdominoperineal resection groups. Forty-six percent of patients had perineal wound sepsis, and 38 percent had perineal wound pain in the abdominoperineal resection group. These complications were absent in Hartmann's procedure group. Postoperative stay was similar in both groups. CONCLUSION: We conclude;hat Hartmann's procedure offer s superior palliation compared with abdominoperineal resection because it provides good symptomatic control without any perineal wound compl ications and pain.