Complications After Rectal Cancer Surgery: Do Female Patients Fare Better? A Retrospective, Matched Cohort Analysis.

Abstract

Background: Rectum cancer is one of the most common cancers in the western world. The path towards personalized treatments in medicine includes further determination of sex-associated differences.

Objective: The study's objective is to explore sex-related differences in the outcome of rectal surgery.

Settings: All patients in the German StuDoQ|Rectum Registry who underwent rectal surgery for rectal cancer between 2013 and 2023 were included.

Design: Propensity score matching was performed to account for comorbidities and factors influencing the surgery-associated outcome. Mediation analysis was performed to show the direct effect of sex on surgical and general complications.

Main outcome measures: The main outcomes are morbidity and mortality.

Patients: The total cohort included 19 664 patients (36.9% women) and 15 011 patients were included in this retrospective study. After propensity score matching, 10 362 patients were analyzed.

Results: Women had fewer surgical complications (e.g., anastomotic leakage, 6.4% vs. 12.0%, p < 0.001), ileus (2.3% vs. 5.7%, p < 0.001)) and fewer general complications (e.g. pneumonia (1.5% vs. 3.6%, p < 0.001). In the propensity score matched cohort (n = 10,362), females had significantly lower odds of experiencing any complication (Clavien-Dindo I-V vs. 0) in matched conditional logistic regression analysis (adjusted odds ratio = 0.614; 95% CI: 0.566-0.666). Despite the strong influence of AL on morbidity, the positive effect of female sex was an independent factor for most complications in this cohort in Mediation Analysis.

Limitations: Our study is limited by its retrospective design and the lack of some information like preoperative nicotine and alcohol consumption or the heterogenous definition of e.g. pelvic abscesses.

Conclusion: In this retrospective multicenter registry study, female sex was associated with favorable outcomes after surgery for rectal cancer. See Video Abstract .