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Purpose <p>Non-restorative surgical options for rectal cancer patients when primary anastomosis is not suitable, Hartmann’s procedure (HP) or intersphincteric abdominoperineal excision (IAPE) are common. Previous studies suggest higher pelvic sepsis after HP, but no data exist comparing exclusively robot-assisted approaches.</p> Methods <p>This retrospective study included rectal cancer patients with significant comorbidities precluding anastomosis. Those patients underwent robot-assisted HP or IAPE at Odense University Hospital (2012–2022). Demographic, 30-day postoperative medical and surgical complications, reoperation, readmission, and 90-day mortality were analysed.</p> Results <p>A total 224 patients were included (HP: <i>n</i> = 57; IAPE: <i>n</i> = 167), HP patients were older (77.0 ± 9.3 vs. 71.7 ± 11.5 years, <i>p</i> = 0.002) and had higher ASA scores (<i>p</i> = 0.001). Postoperative medical complications were low and comparable in both groups. Intra abdominal abscess was also comparable (3.5% for HP vs. 5.4% for IAPE, <i>p</i> = 0.832) Perineal wound infection still present in the IAPE group (6.6%) and perineal pain at 14&#xa0;day was relatively high (11.4%) after IAPE. No significant difference was observed in the rate of readmission, reoperation and 90-day mortality.</p> Conclusion <p>Complications rates did not significantly differ between HP and IAPE. However, IAPE was associated with perineal wound-related morbidity. In patents unfit for anastomosis, robot-assisted HP may considered a better and safer alternative for IAPE.</p>

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Intersphincteric abdominoperineal excision versus low Hartmann’s procedure in the robotic era: a single institution experience

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月2日

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  • Muthanna Al-Jumaili,
  • Aous Al-Sudany,
  • Karam Matlub,
  • Leena Anna Marie Vanderberg,
  • Mark Bremholm Ellebæk,
  • Nuunu Nielsen,
  • Patrick Fuhlendorf,
  • Issam Al-Najami

摘要

Purpose

Non-restorative surgical options for rectal cancer patients when primary anastomosis is not suitable, Hartmann’s procedure (HP) or intersphincteric abdominoperineal excision (IAPE) are common. Previous studies suggest higher pelvic sepsis after HP, but no data exist comparing exclusively robot-assisted approaches.

Methods

This retrospective study included rectal cancer patients with significant comorbidities precluding anastomosis. Those patients underwent robot-assisted HP or IAPE at Odense University Hospital (2012–2022). Demographic, 30-day postoperative medical and surgical complications, reoperation, readmission, and 90-day mortality were analysed.

Results

A total 224 patients were included (HP: n = 57; IAPE: n = 167), HP patients were older (77.0 ± 9.3 vs. 71.7 ± 11.5 years, p = 0.002) and had higher ASA scores (p = 0.001). Postoperative medical complications were low and comparable in both groups. Intra abdominal abscess was also comparable (3.5% for HP vs. 5.4% for IAPE, p = 0.832) Perineal wound infection still present in the IAPE group (6.6%) and perineal pain at 14 day was relatively high (11.4%) after IAPE. No significant difference was observed in the rate of readmission, reoperation and 90-day mortality.

Conclusion

Complications rates did not significantly differ between HP and IAPE. However, IAPE was associated with perineal wound-related morbidity. In patents unfit for anastomosis, robot-assisted HP may considered a better and safer alternative for IAPE.