Surgical endoscopy · 2025
Impact of sex differences on risk factors for postoperative complications in transanal endoscopic surgery for rectal cancer: a large-scale Japanese multicenter cohort study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Miyake Toru, Matsuda Takeru, Takemasa Ichiro, Shibutani Masatsune, Suwa Hirokazu, Terai Shiro, Tani Masaji, Kakeji Yoshihiro, Yamamoto Seiichiro, Naitoh Takeshi, Ta Ta Mi Study Group Collaborators from the Japan Society of Laparoscopic Colorectal Surgery
Аннотация
BACKGROUND: Transanal total mesorectal excision (TaTME) is a novel, minimally invasive surgery for the treatment of rectal cancer. Sex-based anatomical differences such as pelvic morphology may influence surgical difficulty and outcomes. This study aimed to investigate the correlation between sex differences and postoperative complications for patients who have undergone TaTME.
METHODS: This retrospective cohort study was conducted across 26 Japan Society of Laparoscopic Colorectal Surgery centers and included 702 patients who underwent TaTME for the treatment of primary rectal cancer between January 2012 and December 2019. Patients who underwent pelvic exenteration, had recurrent or multiple cancers, or ulcerative colitis were excluded. The primary end point of this study was major postoperative complications (Clavien-Dindo [CD] grade III or higher) within 30 days of surgery. Patient characteristics, operative details, and short-term outcomes were analyzed.
RESULTS: This study included 484 men (68.9%) and 218 women (31.1%), of whom 310 (44.2%) underwent preoperative therapy. A total of 88 patients (12.5%) had CD grade III or higher complications, with a higher incidence in men (14.7%) than women (7.8%) (P = 0.010). In 532 patients with lower rectal tumors located within 5 cm from the anal verge, male sex remained associated with a higher rate of postoperative complications (40.8 vs. 25.4%, P = 0.001). Multivariate analysis identified the following as independent risk factors for major complications: male sex (hazard ratio [HR] = 2.13, 95% confidence interval [CI] 1.200-3.800, P = 0.010), circumferential tumor (HR = 1.82, 95% CI 1.130-2.950, P = 0.014), operative time > 479 min (HR = 1.64, 95% CI 1.010-2.670, P = 0.046), and intraoperative complications during TaTME (HR = 2.17, 95% CI 1.010-4.670, P = 0.048).
CONCLUSIONS: Male sex was a significant risk factor for postoperative complications in TaTME for rectal cancer.
METHODS: This retrospective cohort study was conducted across 26 Japan Society of Laparoscopic Colorectal Surgery centers and included 702 patients who underwent TaTME for the treatment of primary rectal cancer between January 2012 and December 2019. Patients who underwent pelvic exenteration, had recurrent or multiple cancers, or ulcerative colitis were excluded. The primary end point of this study was major postoperative complications (Clavien-Dindo [CD] grade III or higher) within 30 days of surgery. Patient characteristics, operative details, and short-term outcomes were analyzed.
RESULTS: This study included 484 men (68.9%) and 218 women (31.1%), of whom 310 (44.2%) underwent preoperative therapy. A total of 88 patients (12.5%) had CD grade III or higher complications, with a higher incidence in men (14.7%) than women (7.8%) (P = 0.010). In 532 patients with lower rectal tumors located within 5 cm from the anal verge, male sex remained associated with a higher rate of postoperative complications (40.8 vs. 25.4%, P = 0.001). Multivariate analysis identified the following as independent risk factors for major complications: male sex (hazard ratio [HR] = 2.13, 95% confidence interval [CI] 1.200-3.800, P = 0.010), circumferential tumor (HR = 1.82, 95% CI 1.130-2.950, P = 0.014), operative time > 479 min (HR = 1.64, 95% CI 1.010-2.670, P = 0.046), and intraoperative complications during TaTME (HR = 2.17, 95% CI 1.010-4.670, P = 0.048).
CONCLUSIONS: Male sex was a significant risk factor for postoperative complications in TaTME for rectal cancer.