Evidence map›Paper›PMID 41276685›Full record

Observational studyTechniques in coloproctology2025

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 and 6 more

Registry-linked trialAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Techniques in coloproctology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05539417 (Snapshot Rectumcarcinoom 2016), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05539417 completednot on this map

Snapshot Rectumcarcinoom 2016

TypeobservationalSponsorAmsterdam UMC, location VUmcRan2016 to 2016Enrolled3,107ConditionsRectal Cancer
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

E G M van GeffenDepartment of Surgery, Cancer Center Amsterdam, Amsterdam UMC Location Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
F S VerheijDepartment of Surgery, Cancer Center Amsterdam, Amsterdam UMC Location Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
S M J A HazenDepartment of Surgery, Cancer Center Amsterdam, Amsterdam UMC Location Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
T C SluckinDepartment of Surgery, Cancer Center Amsterdam, Amsterdam UMC Location Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
E C J ConstenDepartment of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
J-W T DekkerDepartment of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands.
J NederendDepartment of Radiology, Catharina Hospital, Eindhoven, The Netherlands.
K C M J PeetersDepartment of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
J H W de WiltDepartment of Surgical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands.
S van DierenDepartment of Surgery, Cancer Center Amsterdam, Amsterdam UMC Location Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
R HompesDepartment of Surgery, Cancer Center Amsterdam, Amsterdam UMC Location Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
J B TuynmanDepartment of Surgery, Cancer Center Amsterdam, Amsterdam UMC Location Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
C A M MarijnenDepartment of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands.
P J TanisDepartment of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands. p.tanis@erasmusmc.nl.
M KustersDepartment of Surgery, Cancer Center Amsterdam, Amsterdam UMC Location Vrije Universiteit Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
Dutch Snapshot Research Group

Funding

KWF Kankerbestrijding 12768
6 · The paper itself

Abstract

backgroundIn 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.

methodsAll 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).

resultsOf 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.

conclusionPoor 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 registrationClinicalTrials.gov, identifier NCT05539417, retrospectively registered on September 16, 2022.

Indexed as

Neoplasm Recurrence, LocalProctectomyProctocolectomy, RestorativeRectal NeoplasmsAdultAgedCross-Sectional StudiesDisease-Free SurvivalFemaleHumansMaleMiddle AgedNetherlandsPostoperative ComplicationsRisk FactorsTreatment OutcomeConversion to open surgeryMinimally invasive surgical proceduresRectal cancerResection margins

Identifiers

PMID41276685
PMCPMC12678588

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.