|
|
Back to 2016 Annual Meeting
Rectal Cancer and Gender - Differences of the Perioperative Management, Early Postoperative and Oncosurgical Long-Term Outcome - Data Obtained in a Prospective Multicenter Observational Study
Frank Meyer*1, Julia Katzenstein2, Henry Ptok1, Ronny Otto3, Stefanie Wolff1, Ingo Gastinger3, Hans Lippert3
1Dept. of General, Abdominal and Vascular Surgery, University Hospital at Magdeburg, Magdeburg, Germany; 2Dept. of General and Abdominal Surgery, AMEOS Hospital at Aschersleben, Aschersleben, Germany; 3Institute for Quality Assurance in operative Medicine, Otto-von-Guericke University at Magdeburg, Magdeburg, Germany
Aim: To investigate the impact of gender-specific differences (primary end point) & alterations over various time periods (secundary end point) onto the outcome of surgery in rectal cancer.
Method: Using observational study design, data of periop. management (e.g., tumor site [cm above the anus], exo-[alcohol/nicotine abuse]/endogenic risk factors [obesity, diabetes, cardiovascular], operation [continence-preserving, Hartmann’s procedure], histopathology [tumor stage according to TMN, lymphangio-/venous invasion], intra- [organic lesion, tumor perforation] & postop. complications [anastomotic insufficiency, wound infection/rupture] & neoadjuvant Tx) of consecutive patients with histological diagnosis of rectal cancer were documented in 2005/06 & 2010/11 incl. follow-up.
Results: Overall, 10,657 patients were evaluated, in the majority males (60.9%). Risk factors: Males have (the same in both study periods) a significantly (P<0.001) higher risk by alcohol/nicotine abuse; No. of obese patients increased (other exogenic risk factors were stable over the years).
The No. of MRI/EUS investigations increased rapidly over the years (P<0.001) with greater proportion in men than women (trend). Based on the greater No. of EUS in 2010/11 (males: 65.8%/females: 60.3% versus 0.5% within 2005/2006), a connection with the male gender was found (P<0.001).
There was no significant association between tumor site (cm above the anus) & gender as between histopathological criteria & gender. Neoadjuvant radiochemoTx was significantly more often initiated in males (P<0.001) - no difference between study periods.
Males underwent significantly more often rectum exstirpation (2005/2006: P<0.001; 2010/2011: P=0.05) & experienced significantly more often specific complications (2005/2006: P<0.001; 2010/2011: P<0.001). In contrast, in females Hartmann’s procedure & palliative creation of colostoma were significantly more often performed in both study periods. Early postop. outcome showed a significant difference between males & females in both study periods with regard to 30-day morbidity (P<0.001; hospital lethality: no difference). Overall survival was not significantly different between males & females in both study periods. Local recurrence rate increased through the postoperative course; after 5 years, it is 5% in both genders with no significant difference as it was the same for tumor-free survival in both study periods meaning that local tumor recurrence not metachronous metastases determines tumor-free survival. The 5-year survival rate was appr. 60% in both study periods with no significant association with genders.
Conclusion: Gender contributes to the partially different characteristics of rectal cancer but also providing a substantial impact onto the type of diagnostics & therapeutic procedure as well as early postoperative results but rather less onto the prognosis.
Back to 2016 Annual Meeting
|
