Hartmann's procedure versus intersphincteric abdominoperineal excision (HiP Study): a multicentre prospective cohort study

Research output: Contribution to journalArticlepeer-review

Standard

Hartmann's procedure versus intersphincteric abdominoperineal excision (HiP Study) : a multicentre prospective cohort study. / the HiP collaborators.

In: Colorectal Disease, 08.09.2020.

Research output: Contribution to journalArticlepeer-review

Harvard

APA

Vancouver

Author

Bibtex

@article{ee0c2ce54bb04c93bf628dc7e4d002bc,
title = "Hartmann's procedure versus intersphincteric abdominoperineal excision (HiP Study): a multicentre prospective cohort study",
abstract = "Aim: In patients with low rectal cancer it is occasionally necessary to avoid a low coloanal anastomosis due to patient frailty or poor function. In such situations there are two alternative approaches: Hartmann's procedure (HP) or intersphincteric abdominoperineal excision (IAPE). There are few data to guide surgeons as to which of these two procedures is the safest. The aim of this study was to determine the surgical complication rates associated with each procedure. Method: This was a multicentre, nonrandomized prospective cohort study of patients undergoing either HP or IAPE. The primary objective was to determine surgical complication rates. Secondary objectives included length of stay, time to adjuvant therapy and quality of life at 90 days. Results: One hundred and seventy nine patients were recruited between April 2016 and June 2019; approximately two thirds of patients underwent HP and one third IAPE. The overall complication rate was high in both groups (54% for the HP group and 52% for the IAPE group). Surgery-specific complication rates were also high, but not significantly different: 43% for HP and 48% for IAPE. The pelvic abscess rate in HP was 11% and was significantly higher in patients with a palpable staple line (15% vs 2%). There was a higher incidence of serious medical complications following IAPE (16% vs 5%), along with a reduction in 90-day quality of life scores. Conclusion: This is the largest prospective study to compare HP and IAPE in patients undergoing rectal cancer surgery where primary anastomosis is not deemed appropriate. With similar complication rates, these data support the ongoing use of either HP or IAPE in this patient group.",
keywords = "quality of life, rectal cancer, surgical complications",
author = "{the HiP collaborators} and H. Fowler and R. Clifford and P. Sutton and A. Watson and Nicola Fearnhead and S. Bach and B. Moran and A. Rose and R. Jackson and D. Vimalachandran and Talaka Asmanath and Simon Bach and Krishnamurthy Badrinath and Graham Branagan and Christine Bronder and Deborah Butcher and Jon Lacey-Coulson and Robert Dennis and Sarah Duff and Gemma Gossedge and James Hill and Nicola Fearnhead and James Hernon and Louise Hunt and Aryyal Kamal and Jim Khan and Sushil Masekar and Peter Mitchell and Brendan Moran and Heeam Nassa and Paul Rooney and Adnan Sheikh and Simone Slawik and Chris Smart and Neil Smart and Dave Smith and Doug Speake and Brian Stephenson and Mike Thornton and Samson Tou and Matthew Tutton and Angus Watson and Lesley Wilkinson and Mike Williamson",
year = "2020",
month = sep,
day = "8",
doi = "10.1111/codi.15366",
language = "English",
journal = "Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland",
issn = "1462-8910",
publisher = "Wiley",

}

RIS

TY - JOUR

T1 - Hartmann's procedure versus intersphincteric abdominoperineal excision (HiP Study)

T2 - a multicentre prospective cohort study

AU - the HiP collaborators

AU - Fowler, H.

AU - Clifford, R.

AU - Sutton, P.

AU - Watson, A.

AU - Fearnhead, Nicola

AU - Bach, S.

AU - Moran, B.

AU - Rose, A.

AU - Jackson, R.

AU - Vimalachandran, D.

AU - Asmanath, Talaka

AU - Bach, Simon

AU - Badrinath, Krishnamurthy

AU - Branagan, Graham

AU - Bronder, Christine

AU - Butcher, Deborah

AU - Lacey-Coulson, Jon

AU - Dennis, Robert

AU - Duff, Sarah

AU - Gossedge, Gemma

AU - Hill, James

AU - Fearnhead, Nicola

AU - Hernon, James

AU - Hunt, Louise

AU - Kamal, Aryyal

AU - Khan, Jim

AU - Masekar, Sushil

AU - Mitchell, Peter

AU - Moran, Brendan

AU - Nassa, Heeam

AU - Rooney, Paul

AU - Sheikh, Adnan

AU - Slawik, Simone

AU - Smart, Chris

AU - Smart, Neil

AU - Smith, Dave

AU - Speake, Doug

AU - Stephenson, Brian

AU - Thornton, Mike

AU - Tou, Samson

AU - Tutton, Matthew

AU - Watson, Angus

AU - Wilkinson, Lesley

AU - Williamson, Mike

PY - 2020/9/8

Y1 - 2020/9/8

N2 - Aim: In patients with low rectal cancer it is occasionally necessary to avoid a low coloanal anastomosis due to patient frailty or poor function. In such situations there are two alternative approaches: Hartmann's procedure (HP) or intersphincteric abdominoperineal excision (IAPE). There are few data to guide surgeons as to which of these two procedures is the safest. The aim of this study was to determine the surgical complication rates associated with each procedure. Method: This was a multicentre, nonrandomized prospective cohort study of patients undergoing either HP or IAPE. The primary objective was to determine surgical complication rates. Secondary objectives included length of stay, time to adjuvant therapy and quality of life at 90 days. Results: One hundred and seventy nine patients were recruited between April 2016 and June 2019; approximately two thirds of patients underwent HP and one third IAPE. The overall complication rate was high in both groups (54% for the HP group and 52% for the IAPE group). Surgery-specific complication rates were also high, but not significantly different: 43% for HP and 48% for IAPE. The pelvic abscess rate in HP was 11% and was significantly higher in patients with a palpable staple line (15% vs 2%). There was a higher incidence of serious medical complications following IAPE (16% vs 5%), along with a reduction in 90-day quality of life scores. Conclusion: This is the largest prospective study to compare HP and IAPE in patients undergoing rectal cancer surgery where primary anastomosis is not deemed appropriate. With similar complication rates, these data support the ongoing use of either HP or IAPE in this patient group.

AB - Aim: In patients with low rectal cancer it is occasionally necessary to avoid a low coloanal anastomosis due to patient frailty or poor function. In such situations there are two alternative approaches: Hartmann's procedure (HP) or intersphincteric abdominoperineal excision (IAPE). There are few data to guide surgeons as to which of these two procedures is the safest. The aim of this study was to determine the surgical complication rates associated with each procedure. Method: This was a multicentre, nonrandomized prospective cohort study of patients undergoing either HP or IAPE. The primary objective was to determine surgical complication rates. Secondary objectives included length of stay, time to adjuvant therapy and quality of life at 90 days. Results: One hundred and seventy nine patients were recruited between April 2016 and June 2019; approximately two thirds of patients underwent HP and one third IAPE. The overall complication rate was high in both groups (54% for the HP group and 52% for the IAPE group). Surgery-specific complication rates were also high, but not significantly different: 43% for HP and 48% for IAPE. The pelvic abscess rate in HP was 11% and was significantly higher in patients with a palpable staple line (15% vs 2%). There was a higher incidence of serious medical complications following IAPE (16% vs 5%), along with a reduction in 90-day quality of life scores. Conclusion: This is the largest prospective study to compare HP and IAPE in patients undergoing rectal cancer surgery where primary anastomosis is not deemed appropriate. With similar complication rates, these data support the ongoing use of either HP or IAPE in this patient group.

KW - quality of life

KW - rectal cancer

KW - surgical complications

UR - http://www.scopus.com/inward/record.url?scp=85091788012&partnerID=8YFLogxK

U2 - 10.1111/codi.15366

DO - 10.1111/codi.15366

M3 - Article

JO - Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

JF - Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

SN - 1462-8910

ER -