Z. Sun1, D. P. Nussbaum1, P. J. Speicher1, B. Czito1, D. Tyler1, D. G. Blazer1 1Duke University Medical Center,Durham, NC, USA
Introduction:
Neoadjuvant radiotherapy (RT) as a component of the multimodality approach to gastric cancer has demonstrated promising results in terms of locoregional recurrence, pathologic response, and survival in several institutional series. However, concerns remain about its effect on perioperative morbidity and mortality.
Methods:
The 2005-2011 National Surgical Quality Improvement Program (NSQIP) Participant Data Use File (PUF) was queried for patients undergoing gastrectomy for gastric cancer. Subjects were classified by use of neoadjuvant RT. Perioperative variables and outcomes were compared. Groups were then propensity matched using a 3:1 nearest-neighbor algorithm and multivariable logistic regression was performed to assess neoadjuvant RT as a predictor of outcomes.
Results:
A total of 2,772 patients were identified, among whom 55 (2.0%) underwent neoadjuvant RT. Patients who received neoadjuvant RT were more likely to have received preoperative chemotherapy within 30 days (p<0.001) and steroids (7.3 vs. 1.6%, p=0.007); they were also more likely to have recent weight loss (30.9 vs. 16.2%, p=0.007). However, after propensity matching, all baseline characteristics between groups were highly similar. Concomitant major resection was common for all patients (28.1%), and there was no difference between groups. Total gastrectomy was more common among patients who underwent neoadjuvant RT (70.9 vs. 46.7%, p=0.003), and operative time was considerably longer (290 vs. 236 minutes, p=0.009). There were no differences in overall complications (23.6 vs. 29.7%, p=0.489) or 30-day mortality (3.6 vs. 3.6%, p=0.999). There were also no differences in major complications, surgical site infection, or early reoperation.
Conclusion:
Neoadjuvant RT was not associated with an increase in 30-day mortality or perioperative morbidity after gastrectomy. Given reasonable morbidity demonstrated in our study and other institutional series, neoadjuvant RT warrants further investigation as part of the multidisciplinary management of resectable gastric cancer