性别差异对直肠癌经肛门内镜手术术后并发症危险因素的影响：一项日本大规模多中心队列研究
Impact of sex differences on risk factors for postoperative complications in transanal endoscopic surgery for rectal cancer: a large-scale Japanese multicenter cohort study.
作者信息
Miyake Toru, Matsuda Takeru, Takemasa Ichiro, Shibutani Masatsune, Suwa Hirokazu, Terai Shiro, Tani Masaji, Kakeji Yoshihiro, Yamamoto Seiichiro, Naitoh Takeshi
机构信息
Department of Surgery, Shiga University of Medical Science, Shiga, Japan.
Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, -5-2 Kusunoki-Chou, Chuo-Ku, Kobe, 650-0017, Japan.
出版信息
Surg Endosc. 2025 Aug;39(8):4839-4847. doi: 10.1007/s00464-025-11878-z. Epub 2025 Jun 17.
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.
背景
经肛门全直肠系膜切除术（TaTME）是一种用于治疗直肠癌的新型微创手术。骨盆形态等基于性别的解剖学差异可能会影响手术难度和预后。本研究旨在调查接受TaTME治疗的患者性别差异与术后并发症之间的相关性。
方法
这项回顾性队列研究在26个日本腹腔镜结直肠外科学会中心进行，纳入了2012年1月至2019年12月期间接受TaTME治疗原发性直肠癌的702例患者。排除接受盆腔脏器清除术、患有复发性或多发性癌症或溃疡性结肠炎的患者。本研究的主要终点是术后30天内的主要术后并发症（Clavien-Dindo[CD]Ⅲ级或更高）。分析了患者特征、手术细节和短期预后。
结果
本研究包括484名男性（68.9%）和218名女性（31.1%），其中310名（44.2%）接受了术前治疗。共有88例患者（12.5%）发生CDⅢ级或更高等级的并发症，男性发生率（14.7%）高于女性（7.8%）（P=0.010）。在532例距肛缘5 cm以内的低位直肠肿瘤患者中，男性术后并发症发生率仍然较高（40.8%对25.4%，P=0.001）。多因素分析确定以下因素为主要并发症的独立危险因素：男性（风险比[HR]=2.13，95%置信区间[CI]1.200-3.800，P=0.010）、环周肿瘤（HR=1.82，95%CI 1.130-2.950，P=0.014）、手术时间>479分钟（HR=1.64，95%CI 1.010-2.670，P=0.046）以及TaTME术中并发症（HR=2.17，95%CI 1.010-4.670，P=0.048）。
结论
男性是直肠癌TaTME术后并发症的重要危险因素。
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