Disparities in long‑term outcomes between benign and malignant diseases after Hartmann's procedure: A retrospective observational study

The long-term course following Hartmann's procedure (HP) has not yet been clarified. The present study aimed to compare the achievement of stoma reversal between benign and malignant diseases, and explore post-reversal long-term outcomes. Patients who underwent HP between June 2005 and December 2021 at a single center were retrospectively evaluated. The primary endpoint was the difference in stoma-reversal rate between benign and malignant diseases. The secondary endpoints were identification of the predictive factors for stoma reversal and comparison of stoma-free survival and anorectal functions after reversal between patients with benign and malignant diseases. Among 261 patients, the benign and malignant disease groups comprised 102 and 159 patients, respectively. Malignant disease (P=0.044), low Charlson's comorbidity index (P<0.001), urgent HP (performed as a lifesaving procedure; P=0.003) and home discharge (P<0.001) were significantly associated with stoma reversal in the multivariate analysis. Furthermore, cumulative stoma-reversal rate was significantly lower in the malignant disease than in the benign disease group (P<0.001). In 44 patients who underwent stoma reversal, the rate of stoma-free survival in the malignant disease group was significantly reduced compared with that in the benign disease group at 10 years after reversal (P=0.004). No significant between-group differences were observed regarding anorectal function (n=24). In conclusion, the achievement of stoma reversal and the stoma-free survival rate after reversal may be lower in patients with malignant disease than in those with benign disease; however, anorectal function after reversal may not be markedly different.