Short-term outcomes after minimally invasive surgery: does sex make a difference?

Background: Lung cancer has exponentially increased during the last years among women. The main objective of this study is to comprehensively investigate whether sex has an influence on several variables, with a deeper focus on the perioperative results and short-term outcomes, such as length of hospitalization, drainage, complications and recovery observed in terms of quality of life (QoL), and post-operative/discharge pain, in patients diagnosed with stage I lung cancer who underwent minimally invasive thoracic surgical procedures. Methods: Patients undergoing minimally invasive thoracic surgery for stage I lung cancer from May 1st, 2021 to December 31st, 2023 at San Camillo Forlanini Hospital (Rome, Italy) were retrospectively collected. Data on gender, comorbidities, surgical parameters, complications, tumor characteristics, and postoperative outcomes were collected and analyzed. Associations between categorical variables were assessed by the Fisher’s exact test; for continuous variables, differences between means from two separate groups of subjects were evaluated using the nonparametric Wilcoxon test. In the multivariable analysis, we employed a stepwise selection procedure based on the Akaike Information Criteria. QoL and post-operative pain were assessed using the QLQ-C30 questionnaire. Results: A total of 200 patients were analyzed, 107 females (53.5%) and 93 males (46.5%), with a mean age of 69.5±10.2 years for women and mean age of 73.3±8.69 years for men. Female patients were the predominant group undergoing stage I lung cancer surgery. The distribution of procedures included 129 lobectomies, 19 segmentectomies, and 52 wedge resections, with 94% performed via video-assisted thoracoscopic surgery (VATS) and 6% via robotic-assisted thoracic surgery (RATS). The conversion rate was 2%. Postoperative complications occurred in 21.5% of cases Adenocarcinoma was the predominant histological type (80.5%), more frequent in females. Female patients had a shorter duration of chest drainage (P=0.042), while hospital length of stay and QoL outcomes were similar between genders. A multivariable Poisson regression model identified male gender (P=0.042) and the presence of complications (P<0.001) as factors associated with longer chest drainage duration. Multiportal VATS was associated with longer drainage duration compared to single-port access: patients who underwent two-port (P=0.02), three-port (P=0.02) and four-port (P=0.03) surgeries had significantly longer chest drainage durations compared to one-port access. Conclusions: Our study highlights gender-specific differences in thoracic surgery outcomes for stage I lung cancer. Male gender and post-operative complications are associated with a longer duration of chest drainage. Additionally, two-port and three-port procedures result in longer drainage duration compared to single-port access. No significant differences in QoL or postoperative pain were observed between male and female patients.