Completion of Multimodality Therapy Mitigates the Adverse Impact of Postoperative Complications on Survival in Patients Undergoing Gastrectomy for Advanced Gastric Cancer
*Selena Li1, *Aparna Parikh2, John Mullen2
1Harvard Medical School, Cambridge, MA;2Massachusetts General Hospital, Boston, MA
Objective: To determine the impact of postoperative complications (POCs) on multimodality therapy (MMT) completion rates and overall survival (OS) in advanced gastric cancer patients.
Design: Single institution, retrospective cohort study
Setting: Academic medical center
Patients: 206 patients with advanced gastric cancer undergoing curative-intent surgery from 2001-2015, excluding T1/T2 N0 and M1 disease and 90-day deaths.
Interventions: MMT for advanced gastric cancer.
Main Outcome Measures: OS and MMT completion rates.
Results: A total of 120 patients underwent surgery first (47.5% completed MMT), 58 received perioperative chemotherapy (50% completed MMT), and 28 received total neoadjuvant therapy (all MMT prior to surgery, TNT). Clavien-Dindo grade II/III/IV POCs occurred in 102 (49.5%) patients. At a median follow-up of 37 months, patients with a POC had a 3-year OS of 38.5%, compared to 52.9% (P=0.040) in those without. In contrast, there was no difference in 3-year OS rates (32.8% vs 41.2%, P=0.483) between patients with and without a POC who completed all intended MMT. On multivariate analysis, non-TNT patients who experienced a POC were less likely to complete all intended MMT (HR 0.49, P=0.034), and a POC in these patients had a significant impact on OS (HR 2.19, P=0.016), whereas it did not in patients who completed MMT (HR 1.13, P= 0.704).
Conclusions: Postoperative complications adversely affect long-term survival after gastrectomy for gastric cancer, at least in part via lower completion rates of MMT. Treatment strategies that ensure MMT completion, such as TNT, may be preferable, particularly for patients at high risk for POCs.
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