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Impact of Induction Chemotherapy and Preoperative Chemoradiotherapy on Operative Morbidity and Mortality in Patients with Locoregional Adenocarcinoma of the Stomach or Gastroesophageal Junction

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ABSTRACT

Background

Significant tumor downstaging has been achieved in patients with localized gastric or gastroesophageal adenocarcinoma by induction chemotherapy and preoperative chemoradiotherapy (CTX-CTXRT). However, the influence of CTX-CTXRT on operative morbidity and mortality has not yet been clarified. The aim of the present study was to document the frequency and nature of morbidity and mortality after surgery combined with CTX-CTXRT, and identify factors predictive of postoperative complications in patients with localized gastric or gastroesophageal adenocarcinoma.

Methods

A prospectively collected database on 71 consecutive patients who underwent CTX-CTXRT at M.D. Anderson Cancer Center between January 1997 and August 2004 was reviewed. Postoperative morbidity and mortality were investigated, and risk factors for overall complications were identified by multivariate logistic regression analysis.

Results

Overall morbidity and mortality rates were 38.0% (27 patients) and 2.8% (2 patients), respectively. Age greater than 60 years [relative risk 11.3 (95% confidence interval 2.50–50.6)] and body mass index (BMI) of 26 kg/m2 or above [relative risk 4.08 (95% confidence interval 1.08 to 15.4)] were significant risk factors for overall complications.

Conclusions

CTX-CTXRT can be performed safely with an acceptable operative morbidity and a low operative mortality rate in patients with gastric or gastroesophageal cancer, with careful consideration of added risk associated with age and obesity.

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Authors and Affiliations

  1. Departments of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

    Kazumasa Fujitani, Barry W. Feig, Peter W. Pisters & Paul F. Mansfield

  2. Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

    Jaffer A. Ajani, Angela Welch, Jackie Baker & Josephine Faust

  3. Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

    Christopher H. Crane & Nora Janjan

  4. Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

    Garrett L. Walsh, Stephen G. Swisher, Ara A. Vaporciyan & David Rice

  5. Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, P.O. Box 301402, Unit 444, Houston, TX, 77230-1402, USA

    Paul F. Mansfield

Authors
  1. Kazumasa Fujitani
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  2. Jaffer A. Ajani
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  3. Christopher H. Crane
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  4. Barry W. Feig
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  5. Peter W. Pisters
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  6. Nora Janjan
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  7. Garrett L. Walsh
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  8. Stephen G. Swisher
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  9. Ara A. Vaporciyan
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  10. David Rice
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  11. Angela Welch
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  12. Jackie Baker
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  13. Josephine Faust
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  14. Paul F. Mansfield
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Correspondence to Paul F. Mansfield.

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Fujitani, K., Ajani, J.A., Crane, C.H. et al. Impact of Induction Chemotherapy and Preoperative Chemoradiotherapy on Operative Morbidity and Mortality in Patients with Locoregional Adenocarcinoma of the Stomach or Gastroesophageal Junction. Ann Surg Oncol 14, 2010–2017 (2007). https://doi.org/10.1245/s10434-006-9198-2

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  • DOI: https://doi.org/10.1245/s10434-006-9198-2

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