<p>Postoperative morbidity and mortality after neoadjuvant chemotherapy versus upfront surgery for locally advanced gastric cancer: a propensity score matching analysis</p>

Abstract

Background Cohort studies have shown that neoadjuvant chemotherapy (NAC) is not associated with increased risk of postoperative complications and mortality as compared to upfront surgery (SURG). Objective The aim of this study was to compare postoperative morbidity and mortality after NAC with SURG. Patients and methods Patients who underwent gastrectomy with D2 lymphadenectomy for advanced gastric cancer (GC) between 2010 and 2017 were selected. The impact of neoadjuvant chemotherapy on surgical safety was investigated by using propensity score matching. Results Three hundred and seventy-seven patients were included. After propensity score matching, 86 patients in each group were matched. The percentage of patients with one or more complications was 10.5% in NAC group and 15.1% in SURG group ( P =0.361), there was no mortality developed in either group. The total blood loss was significantly more in the NAC group than that in the SURG group (320.79 vs 243.37 ml, P <0.04). In univariate and multivariate of the matched cohort, sex, age (<70), BMI (<24), ASA grade, surgical procedure (open vs laparoscopy), gastrectomy extent, cTNM and Charlson index comorbidity were not associated with postoperative complications (all P >0.05). Conclusion This study showed that postoperative morbidity and mortality were similar for NAC group and SURG group.

Oncological Outcomes of Laparoscopic Versus Open Gastrectomy After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: A Retrospective Multicenter Study

“…Total blood loss in a neoadjuvant group was substantially higher compared to that of the other group (320,79 vs 243,37 ml; P < 0,04). However, both groups were comparable regarding operative time (P = 0.65), lymph nodes harvested (P = 0.25), multiorgan resection (P = 0.054), and postoperative complications (P = 0.361) 49 .…”

Impact of neoadjuvant chemotherapy on surgical and pathological results of gastric cancer patients: A case‐control study

“…Although NACT for GC is widely accepted and practiced, few studies have investigated the surgical morbidity of this strategy. 11,[23][24][25] T A B L E 3 Postoperative complications Complications SURG NACT II III V Total II III V Total Fistula 6 3 1 10 4 0 0 4 Gastrointestinal 1 4 0 5 0 1 0 1 Thromboembolic 0 1 0 1 0 0 0 0 Pulmonary 0 1 0 1 2 0 0 2 Infection 0 1 0 1 2 0 2 4 Total 7 10 1 18 8 1 2 11 Abbreviations: NACT, neoadjuvant chemotherapy; SURG, patients who underwent upfront gastrectomy. Additionally, survival benefit compared to surgery alone for some cases remains controversial.…”

“…Although NACT for GC is widely accepted and practiced, few studies have investigated the surgical morbidity of this strategy 11,23‐25 . Additionally, survival benefit compared to surgery alone for some cases remains controversial.…”

Optimal Timing to Surgery After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

“…Even after completion, the late toxicity of radiation may greatly bring down patients' quality of life and longterm survival (39,40). The influence of NACT, on the other hand, has neither such solid evidence for a long waiting interval benefit, nor the higher toxicity rate as higher as radiation or chemoradiation (41,42).…”