Male Sex as a Risk Factor for Perioperative Morbidity and Recurrence Following Minimally Invasive Distal Gastrectomy for Gastric Cancer: A Propensity Score Matching Analysis.

[BACKGROUND/AIM] This study aimed to investigate the effect of sex-related differences on surgical outcomes, postoperative complications, and prognosis in patients undergoing minimally invasive distal gastrectomy (MIDG) for gastric cancer (GC).

[PATIENTS AND METHODS] We retrospectively analyzed 988 patients who underwent MIDG for GC at five institutions between January 2018 and December 2024. The patients were categorized according to sex (male or female). To minimize selection bias, propensity score matching (PSM) was performed using the following covariates: age, body mass index, the American Society of Anesthesiologists physical status classification, surgical approach (laparoscopic or robotic), reconstruction method, adjuvant chemotherapy, clinical stage, postoperative complications (Clavien-Dindo classification: CD), and prognoses, including overall survival (OS), relapse-free survival (RFS), and Cancer-Specific Survival (CSS).

[RESULTS] Even after the PSM, male patients demonstrated significantly worse outcomes in surgical and long-term settings. Compared with the females, males had a longer median operation time (293 min . 274 min, <0.001) and greater blood loss (median 5 ml . 0 ml, <0.001). Incidence of postoperative complications (CD II) was significantly higher in the male group (15.4% . 9.5%, =0.037) than that in the female group. Multivariate logistic regression analysis identified male sex as an independent risk factor for postoperative complications (odds ratio: 1.727; 95% confidence interval=1.032-2.939; =0.037). In a multivariate Cox regression analysis, male sex was as an independent risk factor for poorer RFS.

[CONCLUSION] Male patients undergoing MIDG face significantly higher risks of postoperative complications and cancer recurrence than female patients, independent of baseline clinical and pathological factors.