Sex-based differences in outcomes following minimally invasive gastrectomy for gastric cancer: A nationwide study.

Abstract

e16058 Background: Gastric cancer is projected to affect 17,720 men and 12,580 women in 2025, according to the American Cancer Society. Minimally invasive gastrectomy(MIG) has rapidly gained popularity as a safe alternative to open surgery—unfortunately, no gender-based studies comparing postoperative outcomes between males and females after MIG were available. Therefore, we aim to investigate these differences and develop an understanding of the sex-specific outcomes of this procedure, which refers to outcomes unique to each biological sex due to physiological and anatomical differences. Methods: Between 2016 and 2022, we performed a retrospective analysis using the National Inpatient Sample(NIS) database, which includes information on many inpatient stays, to identify gastric cancer patients who underwent MIG. We utilized multivariable regression models to analyze in-hospital complications and any sex-based differences. Results: There were 13,315 MIG procedures, including 8,620 (64.7%) in males and 4,695 (35.3%) in females. Both groups were similar in age (mean age 65.33 years for males vs. 64.71 years for females, p = 0.618) and Charlson Comorbidity Index (CCI) scores (mean CCI 4.06 for males vs. 3.84 for females, p = 0.219). Malnutrition was present in 15.2% of females and 17.6% of males (p < 0.01), while 22.8% of females and 24.8% of males had metastasis (p = 0.011). The multivariable regression revealed that males had higher odds of complications, including surgical wound disruption (aOR 1.843, 95% CI 1.316-2.580, p < 0.01), sepsis (aOR 1.557, 95% CI 1.280-1.894, p < 0.01), pneumothorax (aOR 1.580, 95% CI 1.263-1.977, p < 0.01), and acute kidney injury (AKI) (aOR 1.517, 95% CI 1.305-1.763, p < 0.01). Additionally, males had a higher risk of bleeding (aOR 1.328, 95% CI 1.031-1.711, p < 0.01) but no significant difference in blood transfusion rates (aOR 0.942, 95% CI 0.818-1.084, p = 0.405). Both sexes had similar mortality odds (aOR 1.021, 95% CI 0.753-1.385, p = 0.894). Length of hospital stay was significantly shorter for females (mean 8.04 days) compared to males (mean 8.91 days, p < 0.01). Conclusions: In our study, 64.7% of MIG procedures were performed in males. Males had higher odds of several postoperative complications, including surgical wound disruption, sepsis, pneumothorax, bleeding, and AKI, but no significant differences in blood transfusion rates or mortality. These findings underscore the importance of considering sex-based disparities in postoperative outcomes, as they can inform the development of more effective clinical guidelines for both sexes. Additionally, the limitations of the National Inpatient Sample, including a lack of post-discharge data, indicate the need for future research addressing long-term outcomes and follow-up.