Resection and Primary Anastomosis versus Hartmann's Operation in Emergency Surgery for Acute Mechanical Obstruction due to Left-Sided Colorectal Cancer

Abstract

In cases of obstructed left-sided colorectal cancer, Hartmann's operation or resection and primary anastomosis are alternative surgical methods. Our aim was to compare the outcomes of the two different surgical techniques performed in emergency cases. Obstructed left-sided colorectal cancer patients operated on between 2011 and 2018 were evaluated. Demographics, preoperative laboratory results, American Society of Anesthesiologists scores, types of operative procedures, intraoperative findings, and surgical outcomes were recorded and analyzed. p < 0.05 was accepted as statistically significant. Among the 68 patients included, 46 (67.6%) were men, and 20 (32.4%) were women with a mean age of 64 SD13.9 (range: 35-89). Hartmann's operation was performed in 50 (73.5%) patients, whereas resection and primary anastomosis without the creation of a proximal ostomy were carried out in 18 (26.5%) patients. There were no differences between the two groups in comparison to the American Society of Anesthesiologists scores and the laboratory results except creatinine (p > 0.05). Creatinine levels were higher in the Hartmann's operation group (p < 0.05). Tumors were found to be more commonly located in the descending colon in the resection and primary anastomosis group and in the sigmoid colon in the Hartmann's operation group (p < 0.05). Postoperative complications, length of hospital stay, and mortality rates were similar (p > 0.05). Since there were no significant differences between the use of either Hartmann's operation or primary anastomosis regarding postoperative complications and mortality rates, primary anastomosis may be preferred to Hartmann's operation to avoid the need for a second intervention in emergency surgical cases of obstructed left-sided colorectal cancer.