Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago
Gennaro Perrone, Mario Giuffrida, Fikri M. Abu‐Zidan, Vitor Favali Kruger, Marco Livrini, Gabriele Luciano Petracca, G. Rossi, Antonio Tarasconi, Brian Tian, Elena Bonati, Ricardo Mentz, Federico N. Mazzini, Juan Pablo Campana, Elisabeth Gasser, Reinhold Kafka‐Ritsch, Daniel Moritz Felsenreich, Christopher Dawoud, Stefan Riss, Carlos Augusto Gomes, Felipe Couto GOMES, Ricardo Alessandro Teixeira Gonzaga, Cassio Alfred Brattig Canton, Bruno M. Pereira, Gustavo Pereira Fraga, Leticia Gonçalves Zem, Vinicius Cordeiro-Fonseca, Renato de Mesquita Tauil, Boyko Atanasov, Nikolay Belev, Nikola Kovachev, Libardo J. Meléndez, Ana Dimova, Stefan Dimov, Zdravko Zelić, Goran Augustin, Branko Bogdanić, Trpimir Morić, Élie Chouillard, Melinda Bajul, Belinda De Simone, Yves Panís, Francesco Esposito, Margherita Notarnicola, Lelde Lauka, Adriano Fabbri, Hassen Hentati, Iskander Fnaiech, Venara Aurélien, Marie Bougard, Maxime Roulet, Zaza Demetrashvili, Irakli Pipia, G Merabishvili, Konstantinos Bouliaris, Georgios Koukoulis, Christos Doudakmanis, Sofia Xenaki, Emmanuel Chrysos, Stamatios Kokkinakis, Pantelis Vassiliu, Nikolaos V. Michalopoulos, Ioannis Margaris, Aristotelis Kechagias, Konstantinos Avgerinos, Jevgeni Katunin, Eftychios Lostoridis, Eleni-Aikaterini Nagorni, Antonio Pujante, Francesk Mulita, Ioannis Maroulis, Michail Vailas, Athanasios Marinis, Ioannis Siannis, Eirini Bourbouteli, Dimitrios K. Manatakis, Nikolaos Tasis, Vasileios Acheimastos, Sotiropoulou Maria, Kapiris Stylianos, Harilaos Kuzeridis, Dimitrios Korkolis, Evangelos Fradelos, George Kavalieratos, Thalia Petropoulou, Andreas Polydorou, Ioannis Papacostantinou, Tania Triantafyllou, Despina Kimpizi, Dimitrios Theodorou, Konstantinos Toutouzas, Alexandros Chamzin, Maximos Frountzas, Dimitriοs Schizas, Ioannis Karavokyros, Athanasios Syllaios, Alexandros Charalabopoulos, Maria Boura, Efstratia Baili, Orestis Ioannidis, Lydia Loutzidou
Abstract
BACKGROUND: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. METHODS: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. RESULTS: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. CONCLUSIONS: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception.