Male gender is associated with an increased risk of anastomotic leak in rectal cancer patients after total mesorectal excision

Abstract

BackgroundThe impact of a patient’s gender on the development of anastomotic leak (AL) in rectal cancer patients following total mesorectal excision (TME) remains controversial. The aim of this study was to evaluate the association between patients’ gender and the risk of AL.MethodsAll rectal cancer patients following TME with a primary anastomosis during the study period from 2010 to 2014 were examined. Comparisons of the post-operative AL incidence rate between male and female patients were performed.ResultsOf all patients examined (n = 956), 587 (61.4%) were males and 369 (38.6%) were females. Male patients were more likely to have a history of smoking and drinking alcohol, but less likely to have a history of abdominal surgery compared to female patients. A higher incidence rate of pre-operative bowel obstruction and larger tumor volume in male patients was observed in our study. Of all the patients, 81 (8.5%) developed post-operative AL. More male patients (n = 62, 10.6%) suffered from AL than females (n = 19, 5.1%) (P = 0.003). Multivariate logistic regression analyses confirmed the association between male gender and AL [odds ratio (OR): 2.41, 95% confidence interval (CI): 1.37–4.23, P = 0.002]. Similar results were also obtained in patients who underwent laparoscopic TME (OR: 2.11, 95% CI: 1.15–3.89, P = 0.016).ConclusionsMale patents were found to have an increased risk for AL following TME with a primary anastomosis. A temporary protecting stoma may help to protect the anastomosis and lessen the risk for AL especially in male patients.

Factors influencing intestinal anastomotic leak and their predictive value

“…A similar observation was made in another study conducted in 2003 by Makela et al 6 This result is in contrast with studies that have shown the male gender is an independent risk factor for developing a colonic anastomotic leak. 7,8 It may be because of the presence of multiple risk factors and more number of male patients in our study.…”

The association between the inflammatory response to surgery and postoperative complications in older patients with cancer; a prospective prognostic factor study

“…The distinction in complications rates might be a result of biologic sex-differences. However, other studies show conflicting results [9,43,45].…”

“…Multiple patient-related factors as well as the severity of the surgical procedure itself are associated with adverse postoperative outcomes [7]. Literature shows that pre-existing comorbidities and sex-related differences are associated with outcome in different surgical populations, and that frail patients have a significantly higher morbidity after elective surgical procedures compared to fit patients [8][9][10]. It is likely that the immune system has a role in the pathogenesis of postoperative complications but few inflammatory biomarkers are established to further estimate the risk of postoperative complications across populations [11].…”

Preoperative risk factors associated with anastomotic leakage after colectomy for colorectal cancer: a systematic review and meta-analysis

“…Fourteen studies included in the literature survey evaluated smoking as a risk factor for AL and, of these, nine 3,11,13,20,26,31,42,51,55 showed significant differences between smokers and non-smokers.…”

“…According to previous studies, the predictors of AL are male sex, coronary artery disease, type of surgical procedure, elevated serum albumin, low rectal anastomosis and neoadjuvant radiotherapy 3,4 .…”