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

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.