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The Effect of Neoadjuvant Chemoradiation on Anastomotic Leak and Additional 30-Day Morbidity or Mortality in Patients with Gastric Cancer

Ivy N Haskins, MD1, Matthew D Kroh, MD, FACS1, Richard L Amdur, PhD2, John H Rodriguez, MD, FACS2, Khashayar Vaziri, MD, FACS2. 1Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic Foundation, 2Department of Surgery, George Washington University

Introduction: In addition to increased perioperative morbidity, anastomotic leak following gastric resection for gastric cancer can have detrimental effects on overall- and disease-free survival. The risk of anastomotic leak following neoadjuvant therapy, including chemotherapy and radiation therapy, remains unknown. The purpose of this study is to investigate the association of preoperative chemotherapy and radiation therapy with postoperative anastomotic leak and additional 30-day morbidity and mortality outcomes following total gastrectomy with reconstruction for gastric cancer using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).

Methods: All patients who underwent total gastrectomy with reconstruction for gastric cancer from 2005-2012 were identified. Thirty-day morbidity outcomes included cardiac (cardiac arrest or myocardial infarction), pulmonary (pneumonia, reintubation, or prolonged intubation), wound (superficial, deep, and organ space infections and wound dehiscence), renal (acute kidney injury and acute renal insufficiency requiring dialysis), and venous thromboembolism occurrences. Within the NSQIP database, anastomotic leak is captured as an organ space infection. The association of preoperative chemotherapy and radiation therapy with anastomotic leak and additional 30-day morbidity and mortality outcomes was investigated using chi-square analysis, Fisher’s exact test, and student’s t-test.

Results: A total of 1,135 patients met inclusion criteria; 121 (10.7%) patients underwent preoperative chemotherapy within 30 days of surgery and 53 (4.7%) patients underwent preoperative radiation therapy within 90 days of surgery. Neither preoperative chemotherapy nor radiation therapy was associated with an increased risk of anastomotic leak (p = 0.12 and p = 0.58, respectively). When compared to patients who did not undergo neoadjuvant therapy, patients who underwent either preoperative chemotherapy or radiation therapy did not experience a higher frequency of 30-day mortality (p = 0.41), cardiac (p = 0.49), wound (p = 0.76), renal (p = 0.13), septic (p = 0.55), or venous thromboembolism (p = 0.19) events, and were significantly less likely to experience a pulmonary event (p = 0.02).

Conclusion: Neoadjuvant therapy prior to gastric resection for gastric cancer is not associated with an increased risk of anastomotic leak or other short-term morbidity or mortality.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 79585

Program Number: S035

Presentation Session: Gastric

Presentation Type: Podium

48

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