Effects of immune checkpoint inhibitors on perioperative endocrine abnormalities and intraoperative hemodynamics in patients undergoing radical gastrectomy: a retrospective propensity score-matched cohort study.

[PURPOSE] To assess endocrine immune-related adverse events (irAEs) induced by neoadjuvant immunotherapy, along with effects on perioperative endocrine and hemodynamic parameters.

[METHODS] Gastric cancer patients undergoing radical gastrectomy between April 2024 and April 2025 were retrospectively reviewed. Those who received neoadjuvant immune checkpoint inhibitors (ICIs) were assigned to the ICIs group. Perioperative parameters were compared after propensity score matching (PSM). A subgroup analysis contrasted endocrine irAE cases with matched controls among ICI-treated patients.

[RESULTS] In total, 960 patients were included. Endocrine irAEs occurred in 27.0% (83/307) of patients treated with ICIs. After PSM, preoperative endocrine abnormalities were significantly more common in the ICIs group (24.8% [36/145]) than in the non-ICI group (2.1% [3/145]; P < 0.001). No significant differences were observed between groups in intraoperative hemodynamic parameters or postoperative outcomes. Subgroup analysis of ICI-treated patients showed higher incidences of sustained intraoperative hypotension (systolic arterial pressure < 80 mmHg for > 10 min, P = 0.022; mean arterial pressure < 60 mmHg for > 10 min, P = 0.011) in the endocrine irAEs cohort compared with matched controls. Norepinephrine administration was more frequent (3.8% vs. 0.0%; P = 0.043), and intensive care unit (ICU) admission rate was significantly higher (16.5% [13/79] vs. 5.6% [8/144]; P = 0.008).

[CONCLUSION] Neoadjuvant ICIs are associated with perioperative endocrine dysfunction. Although overall perioperative outcomes remain comparable, intraoperative hemodynamic instability and an elevated ICU admission rate were identified in ICI-treated patients with endocrine irAEs.