Surgical morbidity and mortality after neoadjuvant chemotherapy in the CRITICS gastric cancer trial

Claassen, Y.H.M.; Hartgrink, Henk H.; Dikken, Johan L.; Steur, Wobbe O. de; Sandick, Johanna W. van; Grieken, Nicole C.T. van; Cats, Annemieke; Trip, Anouk Kirsten; Jansen, E.P.M.; Kranenbarg, W.M. Meershoek-Klein; Braak, Jeffrey P.B.M.; Putter, Hein; Henegouwen, Mark I. van Berge; Verheij, Marcel; Velde, C.J.H. van de

doi:10.1016/j.ejso.2018.02.004

Cited by 43 publications

(31 citation statements)

References 27 publications

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“…e influence of neoadjuvant chemotherapy on the operative morbidity and mortality is another critical problem due to the degree of toxicity [20,24]. e most noticeable postoperative complications are surgical site infections including wound infections and intra-abdominal abscess, followed by anastomotic leakage [21,25].…”

Section: Discussionmentioning

confidence: 99%

“…Tumor size and location [22,23,26,27], histopathology [24,28], and radical resection (R0) of the primary tumor [25,26,29,30] are found to have a close relationship with the prognosis of resected GC. For locally resectable advanced gastric cancer, the surgeon should make every effort to achieve complete resection of all gross disease to avoid the possibility of microscopic margin positivity [31].…”

Section: Discussionmentioning

confidence: 99%

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FLOT Neoadjuvant Chemotherapy Followed by Laparoscopic D2 Gastrectomy in the Treatment of Locally Resectable Advanced Gastric Cancer

Zhang

Yan

Sun

et al. 2020

Canadian Journal of Gastroenterology and Hepatology

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Background. The prognosis of patients with advanced gastric cancer remains unsatisfactory, highlighting the need for improved therapeutic strategies. We analyzed 23 resectable advanced gastric cancer patients who received FLOT followed by laparoscopic gastrectomy with D2 lymphadenectomy to evaluate the efficacy and safety. Methods. Patients aged 18–75 years with gastric adenocarcinoma (stage cT3–4 and/or N + M0) underwent neoadjuvant FLOT therapy (four preoperative and four postoperative 2-week cycles) at Shanghai East Hospital. Laparoscopic gastrectomy was scheduled 3-4 weeks after completion of the last cycle of preoperative chemotherapy. The type of surgical procedure was determined by the location and extent of the primary tumor. Results. 23 patients were reviewed in the study. 20 patients (81.2%) received four courses of FOLT therapy, while 3 patients (18.8%) received three courses of treatment. There were 3 (13.0%) complete responses, 13 (56.5%) partial responses, 4 (26.1%) of stable disease, and 1 (4.3%) of progressive disease. The clinical efficacy response rate was 69.6%. The R0 resection rate was 91.3%. Only one patient exhibited grade III postoperative complications. The pathologic complete remission was 13%. The common grade 3/4 adverse events from chemotherapy were leucopenia (17.4%), neutropenia (30.4%), anemia (13%), anorexia (13%), and nausea (17.4%). Postoperative complications occurred in 5 patients (26.1%). There was no treatment-related mortality or reoperation. The most reason for not completing chemotherapy was the patient’s request. Conclusions. These findings suggest that FLOT neoadjuvant chemotherapy, followed by laparoscopic D2 gastrectomy, is effective and safe in advanced, resectable advanced gastric cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

FLOT Neoadjuvant Chemotherapy Followed by Laparoscopic D2 Gastrectomy in the Treatment of Locally Resectable Advanced Gastric Cancer

Zhang

Yan

Sun

et al. 2020

Canadian Journal of Gastroenterology and Hepatology

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“…Above 50% of presenting patients are diagnosed with stage IV disease, precluding curative treatment. For patients with early stage disease, surgery, often combined with neoadjuvant chemotherapy or chemoradiotherapy, offers the best chance of cure [2][3][4][5][6][7].…”

Section: The Need For Better Patient Stratificationmentioning

confidence: 99%

Radiomics in esophageal and gastric cancer

et al. 2018

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Esophageal, esophago-gastric, and gastric cancers are major causes of cancer morbidity and cancer death. For patients with potentially resectable disease, multimodality treatment is recommended as it provides the best chance of survival. However, quality of life may be adversely affected by therapy, and with a wide variation in outcome despite multi-modality therapy, there is a clear need to improve patient stratification. Radiomic approaches provide an opportunity to improve tumor phenotyping. In this review we assess the evidence to date and discuss how these approaches could improve outcome in esophageal, esophago-gastric, and gastric cancer.

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“…The sample size calculation was done using G∗Power 3.1.9.4 software using the reduction of 90 days postoperative complication rates as the primary outcome. Based on the assumption that the percentage of patients developing postoperative complications after gastrectomy is approximately 50% for the control group (based on our centers historical experience and results from RCTs) [ 2 , 3 ] and can be reduced to 25% in the prehabilitation group (based on results of recent RCT showing 50% reduction of postoperative complications by prehabilitation), [ 15 ] a group sample size of 58 patients is needed to achieve 80% power in detecting this difference in 90-days postoperative morbidity at a two-sided level of significance of 5%. Under the assumption of a drop-out rate of up to 10%, a total of 128 patients (64 per group) needs to be enrolled in the study.…”

Section: Methodsmentioning

confidence: 99%

Personalized trimodal prehabilitation for gastrectomy

et al. 2020

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Background: Surgery is the only potentially curative treatment for gastric cancer, however, it bears a high postoperative morbidity and mortality rate. A recent randomized control trial proposed prehabilitation to reduce the postoperative morbidity in patients undergoing major abdominal surgery. Currently, there is a lack of evidence of using prehabilitation for patients undergoing gastrectomy for gastric cancer. The aim of our study is to demonstrate that home-based prehabilitation can reduce postoperative morbidity after gastrectomy for gastric cancer. Methods: PREFOG is a multi-center, open-label randomized control trial comparing 90-days postoperative morbidity rate after gastrectomy for gastric cancer between patients with or without prehabilitation. One-hundred twenty-eight patients will be randomized into an intervention or control group. The intervention arm will receive trimodal home-based prehabilitation including nutritional, psychological and exercise interventions. Secondary outcomes of the study will include physical and nutritional status, anxiety and depression level, quality of life, postoperative mortality rates and full completion of the oncological treatment as determined by the multidisciplinary tumor board. Discussion: PREFOG study will show if home-based trimodal prehabilitation is effective to reduce postoperative morbidity after gastrectomy for gastric cancer. Moreover, this study will allow us to determine whether prehabilitation can improve physical fitness and activity levels, nutritional status and quality of life as well as reducing anxiety and depression levels after gastrectomy for gastric cancer. Trial registration: ClinicalTrials.gov NCT04223401 (First posted: 10 January 2020).

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Surgical morbidity and mortality after neoadjuvant chemotherapy in the CRITICS gastric cancer trial

Cited by 43 publications

References 27 publications

FLOT Neoadjuvant Chemotherapy Followed by Laparoscopic D2 Gastrectomy in the Treatment of Locally Resectable Advanced Gastric Cancer

FLOT Neoadjuvant Chemotherapy Followed by Laparoscopic D2 Gastrectomy in the Treatment of Locally Resectable Advanced Gastric Cancer

Radiomics in esophageal and gastric cancer

Personalized trimodal prehabilitation for gastrectomy

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