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Multicenter Study
. 2025 Aug;39(8):4839-4847.
doi: 10.1007/s00464-025-11878-z. Epub 2025 Jun 17.

Impact of sex differences on risk factors for postoperative complications in transanal endoscopic surgery for rectal cancer: a large-scale Japanese multicenter cohort study

Toru Miyake  1 , Takeru Matsuda  2 , Ichiro Takemasa  3 , Masatsune Shibutani  4 , Hirokazu Suwa  5 , Shiro Terai  6 , Masaji Tani  1 , Yoshihiro Kakeji  7 , Seiichiro Yamamoto  8 , Takeshi Naitoh  9 ; Ta Ta Mi Study Group Collaborators from the Japan Society of Laparoscopic Colorectal Surgery
Collaborators, Affiliations
Multicenter Study

Impact of sex differences on risk factors for postoperative complications in transanal endoscopic surgery for rectal cancer: a large-scale Japanese multicenter cohort study

Toru Miyake et al. Surg Endosc. 2025 Aug.

Abstract

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.

Keywords: Rectal cancer; Sex differences; Transanal total mesorectal excision.

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Conflict of interest statement

Declarations. Disclosures: Toru Miyake, Takeru Matsuda, Ichiro Takemasa, Masatsune Shibutani, Hirokazu Suwa, Shiro Terai, Masaji Tani, Yoshihiro Kakeji, Seiichiro Yamamoto and Takeshi Naitoh have no conflict of interest or financial ties to disclose.

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