Sex-related differences in postoperative complications after pelvic exenteration and their relationship with surgical invasiveness in a multicenter study

PURPOSE: To investigate the sex-related differences in postoperative complications following pelvic exenteration. METHODS: This retrospective subanalysis used a multicenter registry of patients who underwent pelvic exenteration for locally advanced or recurrent rectal cancer. We included 218 patients (177 men and 41 women) in this study. The sex-related differences in postoperative complications were evaluated, and sex-by-factor interactions were assessed using logistic regression models, including sex, each perioperative factor, and the corresponding interaction term. In open surgery, Grade II or higher complications occurred in 82.7% (43/52) of men compared with 38.5% (5/13) of women, whereas no clear sex difference was observed in minimally invasive surgery (69.6% [87/125] vs. 75.0% [21/28]). No significant sex-by-surgical approach interaction was detected for grade III or higher complications. Conversely, a significant sex-by-operative time interaction was observed, which was not apparent for Grade II complications. CONCLUSION: Sex-related differences in postoperative complications after pelvic exenteration were not uniform but emerged with increased surgical invasiveness. Therefore, sex may affect the postoperative risk under conditions of increased surgical stress.