Disparities in Long-Term Outcomes Between Benign and Malignant Diseases After Hartmann’s Procedure: A Retrospective Observational Study

Abstract

Abstract Background: The long-term course following Hartmann’s procedure may vary by primary disease, but remains unclear. Herein, we aimed to compare the incidence of reversal after Hartmann’s procedure (HR) between benign and malignant diseases and explore post-HR long-term outcomes. Methods: Patients who underwent Hartmann’s procedure between June 2005 and December 2021 at a single center were retrospectively evaluated. The primary endpoint was the difference in HR incidence between benign and malignant diseases. The secondary endpoints were identification of the predictive factors for HR incidence and stoma-free survival and anorectal functions after reversal between patients with benign and malignant diseases. Results: Among 261 patients, the benign and malignant disease groups comprised 102 and 159, respectively. Cumulative HR incidence was significantly lower in the in the malignant disease than in the benign disease groups (P <0.001). However, malignant disease was not an independent factor for HR in the multivariate analysis. Low Charlson’s comorbidity index (P <0.001), urgent Hartmann’s procedure (performed as a lifesaving procedure; P <0.001), and home discharge (P <0.001) were significantly associated with HR incidence. Among 43 patients who underwent HR, the rate of stoma-free survival in the malignant disease group reduced significantly as the duration from reversal increased compared with the benign disease group (P=0.020). No significant between-group differences were observed in anorectal function (n=23). Conclusion: The incidence of HR and the stoma-free survival rate after HR may be lower in patients with malignant disease than in those with benign disease, although anorectal function after HR did not differ significantly.