Gender aspects of survival after abdominoperineal resection for low rectal cancer: a retrospective study
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ORIGINAL ARTICLE
Gender aspects of survival after abdominoperineal resection for low rectal cancer: a retrospective study Feng Bao 1 & Jianying Shang 1 & Chunhua Xiang 1 & Guoqiang Li 1 & Xing Zhi 1 & Wen Liu 1 & Dong Wang 1 & Jianbo Xian-Yu 1 & Zhigang Deng 1 Accepted: 10 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The difference in prognosis between genders after abdominoperineal resection (APR) for low rectal cancer (LRC) is unclear. This study aimed to compare survival outcomes between genders in patients with LRC who underwent curative APR. Methods This retrospective cohort study used a database of consecutive colorectal resections. Patients who received curative APR with LRC were grouped according to their gender. Female patients were frequency-matched 1:1 on American Joint Committee on Cancer (AJCC) stage to male patients. Overall survival (OS), disease-free survival (DFS), and their independent risk factors were examined. Results A total of 140 patients with APR for LRC were included after matching: 70 (50.0%) males and 70 (50.0%) females. No significant differences were found between the groups in terms of age, operation methods, AJCC stage, and adjuvant therapy (all P > 0.05). Median follow-up was 39 (range: 3–128) months. Male gender was independently associated with worse OS (adjusted hazard ratio [HR] = 2.755, 95% CI: 1.507–5.038, P = 0.001) and worse DFS (adjusted HR = 2.440, 95% CI: 1.254–4.746, P = 0.009). Subgroup analysis revealed that female patients with stage III disease had better OS (P = 0.001) and DFS (P < 0.001) than male patients. Conclusion Gender affects survival after a curative APR for LRC. Compared with females, male patients with LRC after curative APR had worse prognosis, especially for stage III disease. Keywords Low rectal cancer . Abdominoperineal resection . Gender . Prognosis
Introduction Colorectal cancer (CRC) is the second most common type of cancer in females and the third most common cancer in males worldwide [1]. It is also the fifth leading cause of cancer death in China, and its incidence is rapidly increasing [2, 3]. Meanwhile, the incidence of rectal cancer represents more than 50% of all CRCs in China [4, 5]. Total mesorectal excision (TME) is the standard principle of curative surgery for rectal cancer [6], but with the advances in technical skills, surgical equipment, and neoadjuvant
Feng Bao and Jianying Shang contributed equally to this work. * Zhigang Deng [email protected] 1
Department of General Surgery, Mianyang Central Hospital, 12 Changjia Lane, Jingzhong Street, Mianyang 621000, Sichuan, China
chemoradiotherapy, sphincter-saving resection (SSR) is now a common radical surgical procedure for rectal cancer [7–9]. Accordingly, the need for abdominoperineal resection (APR) has significantly reduced compared to previous decades, avoiding the requirement for a permanent stoma [10] and relatively worse survival outcome [11, 12]. APR is nevertheless accepted as a standard procedure in patients with low rectal
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