Short summary

This project is about patients who are operated for rectal cancer using a robotic method either a low hartmanns procedure or intersphinteric rectum excision. Data is gathered from patient journals from 2012-2022 in Odense university hospital. Followup is planned at 90 and 365 days looking at postoperative complications and mortality.

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Rationale

Patients diagnosed with rectal cancers are often elderly with many comorbidities, and if the tumor is surgically removable, the preferred procedure is often one avoiding high-risk anastomosis. Anastomosis may often be technically possible but cardiovascular and pulmonary comorbidities reduce the chance of anastomosis survival and increase risk of leakage that results in higher morbidity- and complications rates among an older population.

Surgeons have two primary options for treatment that avoids anastomosis. The Hartmann's procedure(HP) performing a total mesorectal resection and then cross stabling the distal remnant or, an abdominoperineal exicison in the intersphinteric plane(IAPE) with the end result being an end-colostomy in both cases. HP has often been the recommended method for the more frail and old population with it being a shorter procedure but it is not without risk. Pelvic abscess being a common and serious risk as shown in a recent study of upwards to 18,6%.

Alternatively the surgeons may choose to perform an IAPE, which is longer procedure with almost no risk of pelvic abscess but commonly perineal wounds requiring longer hospital stay and antibiotic treatment. Few studies have compared these two procedures head to head in regards to complication rate and morbidity. The preferred method seems to be IAPE as a recent retrospective review shows significant increased risk of pelvic abscess performing low HP(17,2%) compared to no events with IAPE and an overall higher surgical complication risk with HP compared to IAPE although not significant 72,4% vs 57,1% (p=0,2) for HP and IAPE respectively.

In recent years, a more modern approach to both surgeries is available with the help of robotics. No study as of yet has compared patients who received robot assisted surgery using either HP or IAPE and compared the complication rate.

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Description of the cohort

We have about 300 participants from the department of surgery in Odense. The study is retrospective.

Data and biological material

Data is gathered from patient journals.

Collaborating researchers and departments

Department of surgery, Odense hospital