Sex-based differences in outcomes following minimally invasive gastrectomy for gastric cancer: A nationwide study.
Bibliographic record
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".