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Effect of Neoadjuvant Chemotherapy on 30-day Morbidity and Mortality Following Resection of Gastric Malignancy
Kate Dinh; Venu Bathini; Bradley Switzer; Mary Sullivan; Giles Whalen; Jennifer LaFemina
University of Massachusetts Medical School, Worcester, MA

Background: The Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial led to the advent of neoadjuvant chemotherapy in the treatment of patients with gastric adenocarcinoma. The MacDonald regimen, in contrast, employs, adjuvant chemotherapy and radiation therapy and has likewise been shown to have a survival benefit. While the former trial demonstrated improved overall survival, the effects of this regimen on 30-day post-operative morbidity and mortality are not well characterized.

Methods:The 2005-2012 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients who underwent gastrectomy for a primary diagnosis of gastric malignancy. Receipt of neoadjuvant chemotherapy up to 30 days prior to surgery was used to predict 30-day post-operative morbidity and mortality, using logistic regression.

Results: 3,614 patients underwent gastrectomy for gastric malignancy. 317 (8.8%) received neoadjuvant chemotherapy in the 30 days prior to resection. Patients who received neoadjuvant chemotherapy had similar 30-day mortality to those who did not (OR 0.67, p=0.29). Patients who received neoadjuvant chemotherapy also had similar rates of 30-day complications, including wound infection, venous thromboembolism, pneumonia, progressive renal insufficiency, stroke, myocardial infarction, and sepsis, compared to those who did not receive neoadjuvant chemotherapy. Patients who received neoadjuvant chemotherapy were less likely to develop post-operative urinary tract infections (OR 0.41, p=0.03).

Conclusion: Patients who were treated with neoadjuvant chemotherapy had similar rates of 30-day post-operative morbidity and mortality following resection of gastric malignancy compared to those who did not receive neoadjuvant chemotherapy.


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