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10.1245/s10434-006-9198-2
Annals of Surgical Oncology 14:2010-2017 (2007)
© 2007 Society of Surgical Oncology
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Original Article

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

Kazumasa Fujitani1, Jaffer A. Ajani2, Christopher H. Crane3, Barry W. Feig1, Peter W. Pisters1, Nora Janjan3, Garrett L. Walsh4, Stephen G. Swisher4, Ara A. Vaporciyan4, David Rice4, Angela Welch2, Jackie Baker2, Josephine Faust2 and Paul F. Mansfield1

1 Departments of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
2 Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
3 Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
4 Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA

Correspondence: Address correspondence and reprint requests to: Paul F. Mansfield, Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, P.O. Box 301402, Unit 444, Houston, TX 77230-1402, USA; E-mail: pmansfie{at}mdanderson.org

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.

Key Words: Morbidity • Mortality • Gastric cancer • Gastroesophageal cancer • Induction chemotherapy • Preoperative chemoradiotherapy






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