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09.07.2018 | Gastrointestinal Oncology | Ausgabe 9/2018

Annals of Surgical Oncology 9/2018

Preoperative Therapy for Gastric Adenocarcinoma is Protective for Poor Oncologic Outcomes in Patients with Complications After Gastrectomy

Zeitschrift:
Annals of Surgical Oncology > Ausgabe 9/2018
Autoren:
MD Diego Vicente, MD Naruhiko Ikoma, MSPH Yi-Ju Chiang, MD Keith Fournier, MD Ching-Wei D. Tzeng, MD, PhD Shumei Song, MD Paul Mansfield, MD Jaffer Ajani, MD, MS Brian D. Badgwell
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1245/​s10434-018-6638-8) contains supplementary material, which is available to authorized users.

Abstract

Background

Postoperative complications (POC) are associated with poor oncologic outcomes in gastric cancer. We sought to evaluate the impact of POC on survival in patients with gastric cancer treated with upfront surgery (UpSurg) versus those treated with preoperative therapy (PreT).

Methods

We analyzed data from a prospectively maintained database of patients who had undergone resection of their gastric cancer at our institution. Patients with T1N0 or M1 lesions, recurrent disease, and mortality within 90 days were excluded. Survival was compared between patients with and without POC in the UpSurg and PreT groups. Cox regression analyses were used to examine factors associated with overall survival (OS) and disease-free survival (DFS).

Results

A total of 421 patients underwent resection of gastric cancer: 30% underwent upfront surgery, and 51% had a POC. Among patients who had POCs, 71% were infectious and 53% were Clavien–Dindo grade III or IV. UpSurg patients with a POC had shorter OS (5-year, 47 vs. 85%; p < 0.001) and DFS (5-year, 46 vs. 76%; p < 0.001) than those without a POC. In contrast, there was no difference in OS (5-year, 57 vs. 63%; p = 0.77) and DFS (5-year, 52 vs. 52%; p = 0.52) between PreT patients with and without POC. Multivariable Cox regression model demonstrated that a POC in UpSurg patients had significant impact on DFS (2.6 [95% confidence interval (CI) 1.48–4.74]), whereas it did not in PreT patients (0.9 [95% CI 0.70–1.33]).

Conclusions

The use of preoperative therapy negated the impact of POCs on OS and DFS in patients undergoing resection for gastric cancer.

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