Gibt es geschlechterspezifische Unterschiede bei Komplikationen in der offenen Viszeralchirurgie?

 

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Zusammenfassung

Untersuchungen im Mausmodell legen geschlechterspezifische Unterschiede bei chirurgischen Komplikationen mit einem eindeutigen Vorteil für weibliche Tiere nahe. Im klinischen Alltag in der offenen Viszeralchirurgie wurde der Genderaspekt bei Komplikationen bisher meist vernachlässigt. Nachgewiesene geschlechterspezifische Unterschiede in der Anatomie, im Hormonstatus, bei konstitutionellen Polymorphismen, in der Immunantwort und Psychologie, die auch unterschiedliche Komplikationswahrscheinlichkeiten und -typen erwarten lassen würden, würden jedoch diesbezügliche Untersuchungen rechtfertigen. Allerdings sind die in der Literatur vorliegenden klinischen Daten spärlich und teilweise sehr heterogen. Während die Datenlage für kolorektale Karzinome noch am besten ist, wird sie dann für Magen, Ösophagus und schließlich Pankreaschirurgie zunehmend spärlicher. Sehr vorsichtig formuliert, lassen sich über alle Organsysteme folgende Trends aus der vorhandenen Literatur ableiten: Männer erleiden tendenziell häufiger postoperative Komplikationen. Bei Männern besteht ein höherer Trend zu Anastomoseninsuffizienzen, während die Anastomosenstenoserate bei Frauen höher zu sein scheint. Derzeit kann aufgrund der vorliegenden Daten allerdings keine Konsequenz für den klinischen Alltag gezogen werden. Daher wäre ein systematischer Einschluss des Genderaspekts in klinische Studien erforderlich, um verwertbare geschlechtsspezifische Daten bez. Komplikationsrate und Komplikationstypen zu generieren.

Abstract

Studies in mice indicate gender-specific differences in surgical complications with a distinct advantage for females. In patient care, however, gender has been an underrated aspect of complication management in abdominal surgery as far. Proven differences between the sexes regarding anatomy, hormonal regulation, constitutional polymorphisms, immune response and psychology suggest different types and incidence of complications and seem to justify studies on the topic. This review aims to compare a selection of current original articles reporting on complications following abdominal surgery separately for the genders. However, data in the literature are sparse and in part very heterogeneous. With data on colorectal carcinoma being most comprehensive, for stomach, oesophagus and finally pancreas fewer data can be found. Summing up all organ systems, the following cautious conclusions can be drawn. Men tend to suffer from postoperative complications more frequently. Men have more cases of anastomotic leakage, whereas women suffer from anastomotic stenosis more often. Currently, however, existing data do not justify any adaptation of patient management. Thus, taking gender aspects into account in designing new trials is paramount in order to obtain robust gender-specific data on incidence and types of complications.

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