Oncological outcomes of planned and unplanned low Hartmann’s procedure and restorative low anterior resection for rectal cancer: a population-based cross-sectional study

E. G. M. van Geffen; F. S. Verheij; S. M. J. A. Hazen; T. C. Sluckin; E. C. J. Consten; J. W. T. Dekker; J. Nederend; K. C. M. J. Peeters; J. H. W. de Wilt; S. van Dieren; R. Hompes; J. B. Tuynman; C. A. M. Marijnen; P. J. Tanis; M. Kusters; the Dutch Snapshot Research Group

doi:10.1007/s10151-025-03169-5

Oncological outcomes of planned and unplanned low Hartmann’s procedure and restorative low anterior resection for rectal cancer: a population-based cross-sectional study

E. G. M. van Geffen
, F. S. Verheij
, S. M. J. A. Hazen
, T. C. Sluckin
, E. C. J. Consten
, J. W. T. Dekker
, J. Nederend
, K. C. M. J. Peeters
, J. H. W. de Wilt
, S. van Dieren
, R. Hompes
, J. B. Tuynman
, C. A. M. Marijnen
, P. J. Tanis^*
, M. Kusters
, the Dutch Snapshot Research Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

1 Downloads (Pure)

Abstract

Background: In the Netherlands, approximately 15% of patients with rectal cancer undergo a low Hartmann’s procedure (low-HP). This is often preoperatively planned to avoid poor functional outcome or complications, but might be unplanned as a result of intraoperative difficulties. Low-HPs seem to be associated with worse oncological outcomes. Methods: All patients who underwent either restorative low anterior resection (rLAR), planned low-HP, or unplanned low-HP for primary rectal cancer in 2016 were included from a nationwide cohort. Main outcomes were 4-year local recurrence (LR) rate and disease-free survival (DFS). Results: Of 2043 patients, 1704 underwent rLAR (83.4%), 253 planned low-HP (12.4%), and 86 unplanned low-HP (4.2%). Among intended rLAR patients (n = 1790), independent risk factors for unplanned low-HP were older age, higher body mass index (BMI), higher American Society of Anesthesiologists (ASA) score, and more distal tumor location. Oncological outcomes after low-HPs were worse than after rLARs (LR 13.7% vs 5.6%, DFS 54.7% vs 71.8%, both p < 0.001), but similar for unplanned and planned low-HP. In multivariable analysis, unplanned and planned low-HP were not associated with LR or DFS, but R1 resection was (HR 6.6 (4.1–10.6), HR 3.0 (2.2–4.0), respectively). In R1 resections, the distal margin was more often involved after low-HP (70.0% vs 28.6%, p = 0.013) compared to rLAR. Conclusion: Poor outcomes in univariable analysis after low-HP appear to be associated with more challenging procedures and increased risk of involved resection margin rather than the low-HP itself. In case of expected difficulties, an extralevator abdominoperineal excision or referral to an expert center might be an alternative to improve resection margins. Trial registration: ClinicalTrials.gov, identifier NCT05539417, retrospectively registered on September 16, 2022.

Original language	English
Article number	4
Journal	Techniques in coloproctology
Volume	30
Issue number	1
DOIs	https://doi.org/10.1007/s10151-025-03169-5
Publication status	Published - 1 Dec 2026

Keywords

Conversion to open surgery
Minimally invasive surgical procedures
Rectal cancer
Resection margins

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10.1007/s10151-025-03169-5

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Cite this

van Geffen, E. G. M., Verheij, F. S., Hazen, S. M. J. A., Sluckin, T. C., Consten, E. C. J., Dekker, J. W. T., Nederend, J., Peeters, K. C. M. J., de Wilt, J. H. W., van Dieren, S., Hompes, R., Tuynman, J. B., Marijnen, C. A. M., Tanis, P. J., Kusters, M., & the Dutch Snapshot Research Group (2026). Oncological outcomes of planned and unplanned low Hartmann’s procedure and restorative low anterior resection for rectal cancer: a population-based cross-sectional study. Techniques in coloproctology, 30(1), Article 4. https://doi.org/10.1007/s10151-025-03169-5

@article{df03501c5a8040069e440a514100cf70,

title = "Oncological outcomes of planned and unplanned low Hartmann{\textquoteright}s procedure and restorative low anterior resection for rectal cancer: a population-based cross-sectional study",

abstract = "Background: In the Netherlands, approximately 15\% of patients with rectal cancer undergo a low Hartmann{\textquoteright}s procedure (low-HP). This is often preoperatively planned to avoid poor functional outcome or complications, but might be unplanned as a result of intraoperative difficulties. Low-HPs seem to be associated with worse oncological outcomes. Methods: All patients who underwent either restorative low anterior resection (rLAR), planned low-HP, or unplanned low-HP for primary rectal cancer in 2016 were included from a nationwide cohort. Main outcomes were 4-year local recurrence (LR) rate and disease-free survival (DFS). Results: Of 2043 patients, 1704 underwent rLAR (83.4\%), 253 planned low-HP (12.4\%), and 86 unplanned low-HP (4.2\%). Among intended rLAR patients (n = 1790), independent risk factors for unplanned low-HP were older age, higher body mass index (BMI), higher American Society of Anesthesiologists (ASA) score, and more distal tumor location. Oncological outcomes after low-HPs were worse than after rLARs (LR 13.7\% vs 5.6\%, DFS 54.7\% vs 71.8\%, both p < 0.001), but similar for unplanned and planned low-HP. In multivariable analysis, unplanned and planned low-HP were not associated with LR or DFS, but R1 resection was (HR 6.6 (4.1–10.6), HR 3.0 (2.2–4.0), respectively). In R1 resections, the distal margin was more often involved after low-HP (70.0\% vs 28.6\%, p = 0.013) compared to rLAR. Conclusion: Poor outcomes in univariable analysis after low-HP appear to be associated with more challenging procedures and increased risk of involved resection margin rather than the low-HP itself. In case of expected difficulties, an extralevator abdominoperineal excision or referral to an expert center might be an alternative to improve resection margins. Trial registration: ClinicalTrials.gov, identifier NCT05539417, retrospectively registered on September 16, 2022.",

keywords = "Conversion to open surgery, Minimally invasive surgical procedures, Rectal cancer, Resection margins",

author = "\{van Geffen\}, \{E. G. M.\} and Verheij, \{F. S.\} and Hazen, \{S. M. J. A.\} and Sluckin, \{T. C.\} and Consten, \{E. C. J.\} and Dekker, \{J. W. T.\} and J. Nederend and Peeters, \{K. C. M. J.\} and \{de Wilt\}, \{J. H. W.\} and \{van Dieren\}, S. and R. Hompes and Tuynman, \{J. B.\} and Marijnen, \{C. A. M.\} and Tanis, \{P. J.\} and M. Kusters and \{the Dutch Snapshot Research Group\} and M. Zorgdrager and Zimmerman, \{D. D. E.\} and Zheng, \{K. J.\} and Zeilstra, \{A. P.\} and \{van der Zee\}, D. and Zandvoort, \{H. J. A.\} and B. Zamaray and \{van der Zaag\}, \{E. S.\} and Wybenga, \{J. M.\} and \{van der Wolk\}, S. and \{van der Wolf\}, \{F. S. W.\} and \{van Woerden\}, V. and K. Woensdregt and F. Wit and \{de Wit\}, \{B. W. K.\} and Wijma, \{A. G.\} and \{van Westreenen\}, \{H. L.\} and \{van Westerveld\}, \{P. P.\} and M. Westerterp and \{van Wely\}, \{B. J.\} and Wegdam, \{J. A.\} and \{van Vugt\}, \{B. S. T.\} and Vroemen, \{J. C.\} and \{de Vries\}, M. and J. Vos-Westerman and Vogelij, \{C. L. A.\} and \{Jeroen Vogelaar\}, F. and S. Voets and Vliegen, \{R. F. A.\} and \{Verwoerd-van Schaik\}, H. and Verschuur, \{A. V. D.\} and Verrijssen, \{A. S. E.\} and M. Vermaas and Verheijen, \{P. M.\} and T. Verhagen and Verduin, \{W. M.\} and Verdaasdonk, \{E. G. G.\} and \{van de Ven\}, \{A. W. H.\} and Velema, \{L. A.\} and Veeken, \{C. J.\} and C. Vasbinder and G. Boudewijn and Vanhooymissen, \{I. J. S.\} and \{van der Valk\}, \{M. J. M.\} and \{van Trier\}, D. and \{van Tilborg\}, F. and \{van Tilborg\}, \{A. A. J. M.\} and Tielbeek, \{J. A. W.\} and Mireille, \{G. Y.\} and Temmink, \{S. J. D.\} and Talsma, \{A. K.\} and J. Stoker and Stam, \{T. C.\} and Spruit, \{P. H.\} and Spillenaar-Bilgen, \{E. J.\} and Smits, \{A. B.\} and Smalbroek, \{B. P.\} and \{van der Sluis\}, M. and Slooter, \{G. D.\} and Slob, \{M. J.\} and Simons, \{P. C. G.\} and C. Sietses and Schuivens, \{P. M. E.\} and Schreurs, \{W. H.\} and \{Schouten van der Velden\}, \{A. P.\} and Scheurkogel, \{M. M.\} and Schasfoort, \{R. A.\} and Schaafsma, \{B. E.\} and \{van der Sande\}, \{M. E.\} and Rutten, \{H. J. T.\} and H. R{\"u}tten and T. Rozema and Rouw, \{D. B.\} and J. Rothbarth and \{Roskott-ten Brinke\}, \{E. A.\} and Roosen, \{L. J.\} and Rombouts, \{A. J. M.\} and Renger, \{R. J.\} and \{van Rees\}, \{J. M.\} and Qaderi, \{S. M.\} and Pultrum, \{B. B.\} and Prette, \{J. F.\} and Posma, \{L. A. E.\} and Poodt, \{I. G. M.\} and F. Polat and Plate, \{J. D. J.\} and Z. Pironet and J. Peringa and Pereboom, \{I. T. A.\} and I. Paulusma and P. Ott and V. Oppedijk and D. Ootes and Oosterling, \{S. J.\} and Olthof, \{P. B.\} and S. Nordkamp and Noordman, \{B. J.\} and J. Nonner and Nieuwenhuis, \{J. F.\} and \{van den Nieuwboer\}, \{J. B. J.\} and M. Nielen and \{de Nes\}, \{L. C. F.\} and Neijenhuis, \{P. A.\} and Musters, \{G. D.\} and K. Muller and Mulder, \{E. J.\} and L. Morsink and J. Moelker-Galuzina and \{de Mey\}, \{D. J. L.\} and J. Melenhorst and P. Meijnen and \{van der Meij\}, W. and I. Masselink and Martens, \{M. H.\} and Marsman, \{M. S.\} and \{de Lijster\}, \{M. S.\} and Leseman-Hoogenboom, \{M. M.\} and Leijtens, \{J. W. A.\} and \{van Landeghem\}, \{A. A. G.\} and B. Lamme and Lahuis, \{D. H. H.\} and Krul, \{E. J. T.\} and Kroese, \{L. F.\} and P. Krielen and J. Krdzalic and Koster, \{I. M.\} and Korving, \{J. C.\} and Kortekaas, \{R. T. J.\} and \{de Korte\}, \{F. I.\} and Kolderman, \{S. E. M.\} and S. Kok and \{van Koeverden\}, S. and E. Kn{\"o}ps and Ketelaers, \{S. H. J.\} and B. Keizers and D. Jou-Valencia and J. Jonkers and \{de Jong\}, \{C. E. J.\} and P. Janssen and Intven, \{M. P. W.\} and B. Inberg and F. Imani and \{van Hulst\}, R. and \{van der Hul\}, \{R. L.\} and K. Horsthuis and \{van Hoorn\}, F. and S. Hoogendoorn and Hogewoning, \{C. R. C.\} and A. Hogewoning and C. Hoff and \{van der Hoeven\}, \{E. J. R. J.\} and \{van den Hoek\}, S. and Hendriksen, \{E. M.\} and Heikens, \{J. T.\} and V. Heesink and \{den Hartogh\}, \{M. D.\} and Hakkenbrak, \{N. A. G.\} and \{de Haas\}, \{R. J.\} and \{de Groot\}, I. and \{de Groof\}, \{E. J.\} and \{van Grevenstein\}, \{W. M. U.\} and Govaert, \{M. J. P. M.\} and L. Goense and \{van Gils\}, \{R. A. H.\} and H. Gielkens and Gerhards, \{M. F.\} and \{van Geloven\}, \{A. A. W.\} and Geijsen, \{E. D.\} and \{van Geel\}, \{A. M.\} and Furn{\'e}e, \{E. J. B.\} and B. Frietman and Feshtali, \{S. S.\} and Feitsma, \{E. A.\} and T. Fassaert and Fabry, \{H. F. J.\} and \{van Essen\}, \{J. A.\} and \{van Erp\}, \{A. C.\} and M. Engelbrecht and Emmen, \{A. M. L. H.\} and \{van Elderen\}, S. and Y. el-Massoudi and B. Eijlers and \{van Egdom\}, \{L. S. E.\} and \{van Duyn\}, \{E. B.\} and J. Duyck and Dunker, \{M. S.\} and Duijsens, \{H. M. H.\} and \{Droogh-de Greve\}, \{K. E.\} and \{van Dop\}, \{I. M.\} and K. Dogan and Dinaux, \{A. M.\} and Diederik, \{A. L.\} and T. Derksen and A. Demirkiran and Dekker, \{E. N.\} and Davids, \{P. H. P.\} and Dani{\"e}ls-Gooszen, \{A. W.\} and S. Curutchet and Crolla, \{R. M. P. H.\} and M. Corver and \{Coebergh van den Braak\}, \{R. R. J.\} and Cnossen, \{J. S.\} and Ceha, \{H. M.\} and \{ten Cate\}, \{D. W. G.\} and Burghgraef, \{T. A.\} and Burger, \{J. W. A.\} and \{van der Burg\}, \{S. W.\} and \{van den Broek\}, \{W. T.\} and \{van Breest Smallenburg\}, V. and Brandsma, \{A. T. A.\} and J. Bradshaw and Braat, \{M. N. G. J. A.\} and Braak, \{S. J.\} and Bouwman, \{J. E.\} and Borstlap, \{W. A. A.\} and J. Borstlap and Boogerd, \{L. S. F.\} and Boerma, \{E. J. G.\} and \{den Boer\}, \{F. C.\} and Boer, \{A. H.\} and \{van Bockel\}, \{L. W.\} and Blok, \{R. D.\} and Bisschops, \{R. H. C.\} and \{de Bie\}, \{S. H.\} and M. Berb{\'e}e and Bemelman, \{W. A.\} and Beets-Tan, \{R. G. H.\} and Beets, \{G. L.\} and Beekhuis, \{H. M. D.\} and Barendse, \{R. M.\} and F. Bangert and Bakker, \{I. S.\} and Bakers, \{F. C. H.\} and Bahadoer, \{R. R.\} and H. Avenarius and Aukema, \{T. S.\} and Ashruf, \{J. F.\} and Antonisse, \{I. E.\} and M. Ankersmit and Amelung, \{F. J.\} and \{van Aalten\}, \{S. M.\} and Aalbers, \{A. G. J.\}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2026",

month = dec,

day = "1",

doi = "10.1007/s10151-025-03169-5",

language = "English",

volume = "30",

journal = "Techniques in coloproctology",

issn = "1123-6337",

publisher = "Springer-Verlag Italia",

number = "1",

}

van Geffen, EGM , Verheij, FS, Hazen, SMJA, Sluckin, TC, Consten, ECJ, Dekker, JWT, Nederend, J, Peeters, KCMJ, de Wilt, JHW, van Dieren, S , Hompes, R , Tuynman, JB, Marijnen, CAM, Tanis, PJ , Kusters, M & the Dutch Snapshot Research Group 2026, 'Oncological outcomes of planned and unplanned low Hartmann’s procedure and restorative low anterior resection for rectal cancer: a population-based cross-sectional study', Techniques in coloproctology, vol. 30, no. 1, 4. https://doi.org/10.1007/s10151-025-03169-5

Oncological outcomes of planned and unplanned low Hartmann’s procedure and restorative low anterior resection for rectal cancer: a population-based cross-sectional study. / van Geffen, E. G. M.; Verheij, F. S.; Hazen, S. M. J. A. et al.
In: Techniques in coloproctology, Vol. 30, No. 1, 4, 01.12.2026.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Oncological outcomes of planned and unplanned low Hartmann’s procedure and restorative low anterior resection for rectal cancer

T2 - a population-based cross-sectional study

AU - van Geffen, E. G. M.

AU - Verheij, F. S.

AU - Hazen, S. M. J. A.

AU - Sluckin, T. C.

AU - Consten, E. C. J.

AU - Dekker, J. W. T.

AU - Nederend, J.

AU - Peeters, K. C. M. J.

AU - de Wilt, J. H. W.

AU - van Dieren, S.

AU - Hompes, R.

AU - Tuynman, J. B.

AU - Marijnen, C. A. M.

AU - Tanis, P. J.

AU - Kusters, M.

AU - the Dutch Snapshot Research Group

AU - Zorgdrager, M.

AU - Zimmerman, D. D. E.

AU - Zheng, K. J.

AU - Zeilstra, A. P.

AU - van der Zee, D.

AU - Zandvoort, H. J. A.

AU - Zamaray, B.

AU - van der Zaag, E. S.

AU - Wybenga, J. M.

AU - van der Wolk, S.

AU - van der Wolf, F. S. W.

AU - van Woerden, V.

AU - Woensdregt, K.

AU - Wit, F.

AU - de Wit, B. W. K.

AU - Wijma, A. G.

AU - van Westreenen, H. L.

AU - van Westerveld, P. P.

AU - Westerterp, M.

AU - van Wely, B. J.

AU - Wegdam, J. A.

AU - van Vugt, B. S. T.

AU - Vroemen, J. C.

AU - de Vries, M.

AU - Vos-Westerman, J.

AU - Vogelij, C. L. A.

AU - Jeroen Vogelaar, F.

AU - Voets, S.

AU - Vliegen, R. F. A.

AU - Verwoerd-van Schaik, H.

AU - Verschuur, A. V. D.

AU - Verrijssen, A. S. E.

AU - Vermaas, M.

AU - Verheijen, P. M.

AU - Verhagen, T.

AU - Verduin, W. M.

AU - Verdaasdonk, E. G. G.

AU - van de Ven, A. W. H.

AU - Velema, L. A.

AU - Veeken, C. J.

AU - Vasbinder, C.

AU - Boudewijn, G.

AU - Vanhooymissen, I. J. S.

AU - van der Valk, M. J. M.

AU - van Trier, D.

AU - van Tilborg, F.

AU - van Tilborg, A. A. J. M.

AU - Tielbeek, J. A. W.

AU - Mireille, G. Y.

AU - Temmink, S. J. D.

AU - Talsma, A. K.

AU - Stoker, J.

AU - Stam, T. C.

AU - Spruit, P. H.

AU - Spillenaar-Bilgen, E. J.

AU - Smits, A. B.

AU - Smalbroek, B. P.

AU - van der Sluis, M.

AU - Slooter, G. D.

AU - Slob, M. J.

AU - Simons, P. C. G.

AU - Sietses, C.

AU - Schuivens, P. M. E.

AU - Schreurs, W. H.

AU - Schouten van der Velden, A. P.

AU - Scheurkogel, M. M.

AU - Schasfoort, R. A.

AU - Schaafsma, B. E.

AU - van der Sande, M. E.

AU - Rutten, H. J. T.

AU - Rütten, H.

AU - Rozema, T.

AU - Rouw, D. B.

AU - Rothbarth, J.

AU - Roskott-ten Brinke, E. A.

AU - Roosen, L. J.

AU - Rombouts, A. J. M.

AU - Renger, R. J.

AU - van Rees, J. M.

AU - Qaderi, S. M.

AU - Pultrum, B. B.

AU - Prette, J. F.

AU - Posma, L. A. E.

AU - Poodt, I. G. M.

AU - Polat, F.

AU - Plate, J. D. J.

AU - Pironet, Z.

AU - Peringa, J.

AU - Pereboom, I. T. A.

AU - Paulusma, I.

AU - Ott, P.

AU - Oppedijk, V.

AU - Ootes, D.

AU - Oosterling, S. J.

AU - Olthof, P. B.

AU - Nordkamp, S.

AU - Noordman, B. J.

AU - Nonner, J.

AU - Nieuwenhuis, J. F.

AU - van den Nieuwboer, J. B. J.

AU - Nielen, M.

AU - de Nes, L. C. F.

AU - Neijenhuis, P. A.

AU - Musters, G. D.

AU - Muller, K.

AU - Mulder, E. J.

AU - Morsink, L.

AU - Moelker-Galuzina, J.

AU - de Mey, D. J. L.

AU - Melenhorst, J.

AU - Meijnen, P.

AU - van der Meij, W.

AU - Masselink, I.

AU - Martens, M. H.

AU - Marsman, M. S.

AU - de Lijster, M. S.

AU - Leseman-Hoogenboom, M. M.

AU - Leijtens, J. W. A.

AU - van Landeghem, A. A. G.

AU - Lamme, B.

AU - Lahuis, D. H. H.

AU - Krul, E. J. T.

AU - Kroese, L. F.

AU - Krielen, P.

AU - Krdzalic, J.

AU - Koster, I. M.

AU - Korving, J. C.

AU - Kortekaas, R. T. J.

AU - de Korte, F. I.

AU - Kolderman, S. E. M.

AU - Kok, S.

AU - van Koeverden, S.

AU - Knöps, E.

AU - Ketelaers, S. H. J.

AU - Keizers, B.

AU - Jou-Valencia, D.

AU - Jonkers, J.

AU - de Jong, C. E. J.

AU - Janssen, P.

AU - Intven, M. P. W.

AU - Inberg, B.

AU - Imani, F.

AU - van Hulst, R.

AU - van der Hul, R. L.

AU - Horsthuis, K.

AU - van Hoorn, F.

AU - Hoogendoorn, S.

AU - Hogewoning, C. R. C.

AU - Hogewoning, A.

AU - Hoff, C.

AU - van der Hoeven, E. J. R. J.

AU - van den Hoek, S.

AU - Hendriksen, E. M.

AU - Heikens, J. T.

AU - Heesink, V.

AU - den Hartogh, M. D.

AU - Hakkenbrak, N. A. G.

AU - de Haas, R. J.

AU - de Groot, I.

AU - de Groof, E. J.

AU - van Grevenstein, W. M. U.

AU - Govaert, M. J. P. M.

AU - Goense, L.

AU - van Gils, R. A. H.

AU - Gielkens, H.

AU - Gerhards, M. F.

AU - van Geloven, A. A. W.

AU - Geijsen, E. D.

AU - van Geel, A. M.

AU - Furnée, E. J. B.

AU - Frietman, B.

AU - Feshtali, S. S.

AU - Feitsma, E. A.

AU - Fassaert, T.

AU - Fabry, H. F. J.

AU - van Essen, J. A.

AU - van Erp, A. C.

AU - Engelbrecht, M.

AU - Emmen, A. M. L. H.

AU - van Elderen, S.

AU - el-Massoudi, Y.

AU - Eijlers, B.

AU - van Egdom, L. S. E.

AU - van Duyn, E. B.

AU - Duyck, J.

AU - Dunker, M. S.

AU - Duijsens, H. M. H.

AU - Droogh-de Greve, K. E.

AU - van Dop, I. M.

AU - Dogan, K.

AU - Dinaux, A. M.

AU - Diederik, A. L.

AU - Derksen, T.

AU - Demirkiran, A.

AU - Dekker, E. N.

AU - Davids, P. H. P.

AU - Daniëls-Gooszen, A. W.

AU - Curutchet, S.

AU - Crolla, R. M. P. H.

AU - Corver, M.

AU - Coebergh van den Braak, R. R. J.

AU - Cnossen, J. S.

AU - Ceha, H. M.

AU - ten Cate, D. W. G.

AU - Burghgraef, T. A.

AU - Burger, J. W. A.

AU - van der Burg, S. W.

AU - van den Broek, W. T.

AU - van Breest Smallenburg, V.

AU - Brandsma, A. T. A.

AU - Bradshaw, J.

AU - Braat, M. N. G. J. A.

AU - Braak, S. J.

AU - Bouwman, J. E.

AU - Borstlap, W. A. A.

AU - Borstlap, J.

AU - Boogerd, L. S. F.

AU - Boerma, E. J. G.

AU - den Boer, F. C.

AU - Boer, A. H.

AU - van Bockel, L. W.

AU - Blok, R. D.

AU - Bisschops, R. H. C.

AU - de Bie, S. H.

AU - Berbée, M.

AU - Bemelman, W. A.

AU - Beets-Tan, R. G. H.

AU - Beets, G. L.

AU - Beekhuis, H. M. D.

AU - Barendse, R. M.

AU - Bangert, F.

AU - Bakker, I. S.

AU - Bakers, F. C. H.

AU - Bahadoer, R. R.

AU - Avenarius, H.

AU - Aukema, T. S.

AU - Ashruf, J. F.

AU - Antonisse, I. E.

AU - Ankersmit, M.

AU - Amelung, F. J.

AU - van Aalten, S. M.

AU - Aalbers, A. G. J.

PY - 2026/12/1

Y1 - 2026/12/1

N2 - Background: In the Netherlands, approximately 15% of patients with rectal cancer undergo a low Hartmann’s procedure (low-HP). This is often preoperatively planned to avoid poor functional outcome or complications, but might be unplanned as a result of intraoperative difficulties. Low-HPs seem to be associated with worse oncological outcomes. Methods: All patients who underwent either restorative low anterior resection (rLAR), planned low-HP, or unplanned low-HP for primary rectal cancer in 2016 were included from a nationwide cohort. Main outcomes were 4-year local recurrence (LR) rate and disease-free survival (DFS). Results: Of 2043 patients, 1704 underwent rLAR (83.4%), 253 planned low-HP (12.4%), and 86 unplanned low-HP (4.2%). Among intended rLAR patients (n = 1790), independent risk factors for unplanned low-HP were older age, higher body mass index (BMI), higher American Society of Anesthesiologists (ASA) score, and more distal tumor location. Oncological outcomes after low-HPs were worse than after rLARs (LR 13.7% vs 5.6%, DFS 54.7% vs 71.8%, both p < 0.001), but similar for unplanned and planned low-HP. In multivariable analysis, unplanned and planned low-HP were not associated with LR or DFS, but R1 resection was (HR 6.6 (4.1–10.6), HR 3.0 (2.2–4.0), respectively). In R1 resections, the distal margin was more often involved after low-HP (70.0% vs 28.6%, p = 0.013) compared to rLAR. Conclusion: Poor outcomes in univariable analysis after low-HP appear to be associated with more challenging procedures and increased risk of involved resection margin rather than the low-HP itself. In case of expected difficulties, an extralevator abdominoperineal excision or referral to an expert center might be an alternative to improve resection margins. Trial registration: ClinicalTrials.gov, identifier NCT05539417, retrospectively registered on September 16, 2022.

AB - Background: In the Netherlands, approximately 15% of patients with rectal cancer undergo a low Hartmann’s procedure (low-HP). This is often preoperatively planned to avoid poor functional outcome or complications, but might be unplanned as a result of intraoperative difficulties. Low-HPs seem to be associated with worse oncological outcomes. Methods: All patients who underwent either restorative low anterior resection (rLAR), planned low-HP, or unplanned low-HP for primary rectal cancer in 2016 were included from a nationwide cohort. Main outcomes were 4-year local recurrence (LR) rate and disease-free survival (DFS). Results: Of 2043 patients, 1704 underwent rLAR (83.4%), 253 planned low-HP (12.4%), and 86 unplanned low-HP (4.2%). Among intended rLAR patients (n = 1790), independent risk factors for unplanned low-HP were older age, higher body mass index (BMI), higher American Society of Anesthesiologists (ASA) score, and more distal tumor location. Oncological outcomes after low-HPs were worse than after rLARs (LR 13.7% vs 5.6%, DFS 54.7% vs 71.8%, both p < 0.001), but similar for unplanned and planned low-HP. In multivariable analysis, unplanned and planned low-HP were not associated with LR or DFS, but R1 resection was (HR 6.6 (4.1–10.6), HR 3.0 (2.2–4.0), respectively). In R1 resections, the distal margin was more often involved after low-HP (70.0% vs 28.6%, p = 0.013) compared to rLAR. Conclusion: Poor outcomes in univariable analysis after low-HP appear to be associated with more challenging procedures and increased risk of involved resection margin rather than the low-HP itself. In case of expected difficulties, an extralevator abdominoperineal excision or referral to an expert center might be an alternative to improve resection margins. Trial registration: ClinicalTrials.gov, identifier NCT05539417, retrospectively registered on September 16, 2022.

KW - Conversion to open surgery

KW - Minimally invasive surgical procedures

KW - Rectal cancer

KW - Resection margins

UR - https://www.scopus.com/pages/publications/105023864293

U2 - 10.1007/s10151-025-03169-5

DO - 10.1007/s10151-025-03169-5

M3 - Article

C2 - 41276685

SN - 1123-6337

VL - 30

JO - Techniques in coloproctology

JF - Techniques in coloproctology

IS - 1

M1 - 4

ER -

Oncological outcomes of planned and unplanned low Hartmann’s procedure and restorative low anterior resection for rectal cancer: a population-based cross-sectional study

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