Naruhiko Ikoma1, Prajnan Das2, Mariela Blum3, Jeannelyn S Estrella4, Catherine E Devine5, Xuemei Wang6, Keith Fournier1, Paul Mansfield1, Bruce D Minsky2, Jaffer Ajani3, Brian D Badgwell7. 1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 3. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 4. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 5. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 6. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas. 7. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: bbadgwell@mdanderson.org.
Abstract
INTRODUCTION: We sought to determine whether preoperative chemoradiation therapy or chemotherapy increases the risk of anastomotic leak after gastrectomy in gastric cancer patients without gastroesophageal junction involvement. METHODS: We reviewed data from a prospectively maintained database of patients who underwent gastrectomy at our institution between 2001 and 2016. The incidence of anastomotic leak and symptomatic intra-abdominal fluid collection was determined and tested for associations with the type of preoperative therapy. Risk factors for these adverse events were identified by univariate and multivariable logistic regression models. RESULTS: Of 346 included patients, 35% had upfront surgery, 44% had preoperative chemoradiation therapy, and 21% had preoperative chemotherapy. Anastomotic leak and intra-abdominal fluid collection were diagnosed in 3.5% and 7.5% of patients, respectively. Multivariable analysis revealed that concomitant organ resection was the only significant risk factor for anastomotic leak or intra-abdominal fluid collection (P=.014). The type of preoperative therapy was not a risk factor for anastomotic leak or intra-abdominal fluid collection. CONCLUSIONS: Anastomotic leak and intra-abdominal fluid collection were rare after gastrectomy, and neither type of preoperative therapy increased the risk of these adverse events. Our results add to the existing literature that preoperative therapy, including preoperative chemoradiation therapy, is safe for patients with gastric cancer.
INTRODUCTION: We sought to determine whether preoperative chemoradiation therapy or chemotherapy increases the risk of anastomotic leak after gastrectomy in gastric cancerpatients without gastroesophageal junction involvement. METHODS: We reviewed data from a prospectively maintained database of patients who underwent gastrectomy at our institution between 2001 and 2016. The incidence of anastomotic leak and symptomatic intra-abdominal fluid collection was determined and tested for associations with the type of preoperative therapy. Risk factors for these adverse events were identified by univariate and multivariable logistic regression models. RESULTS: Of 346 included patients, 35% had upfront surgery, 44% had preoperative chemoradiation therapy, and 21% had preoperative chemotherapy. Anastomotic leak and intra-abdominal fluid collection were diagnosed in 3.5% and 7.5% of patients, respectively. Multivariable analysis revealed that concomitant organ resection was the only significant risk factor for anastomotic leak or intra-abdominal fluid collection (P=.014). The type of preoperative therapy was not a risk factor for anastomotic leak or intra-abdominal fluid collection. CONCLUSIONS:Anastomotic leak and intra-abdominal fluid collection were rare after gastrectomy, and neither type of preoperative therapy increased the risk of these adverse events. Our results add to the existing literature that preoperative therapy, including preoperative chemoradiation therapy, is safe for patients with gastric cancer.
Authors: Naruhiko Ikoma; Prajnan Das; Wayne Hofstetter; Jaffer A Ajani; Jeannelyn S Estrella; Hsiang-Chun Chen; Xuemei Wang; Rashida A Callender; Cong Zhu; Christina L Roland; Keith F Fournier; Janice N Cormier; Paul Mansfield; Brian D Badgwell Journal: Gastric Cancer Date: 2018-05-05 Impact factor: 7.370
Authors: Naruhiko Ikoma; Jeannelyn S Estrella; Mariela Blum Murphy; Prajnan Das; Bruce D Minsky; Paul Mansfield; Jaffer A Ajani; Brian D Badgwell Journal: J Gastrointest Surg Date: 2020-06-15 Impact factor: 3.452
Authors: Astrid E Slagter; Marieke A Vollebergh; Edwin P M Jansen; Johanna W van Sandick; Annemieke Cats; Nicole C T van Grieken; Marcel Verheij Journal: Front Oncol Date: 2020-11-30 Impact factor: 6.244
Authors: Casey J Allen; Alisa N Blumenthaler; Grace L Smith; Prajnan Das; Bruce D Minsky; Mariela Blum; Jaffer Ajani; Paul F Mansfield; Naruhiko Ikoma; Brian D Badgwell Journal: Ann Surg Oncol Date: 2020-07-21 Impact factor: 5.344
Authors: Casey J Allen; David T Pointer; Alisa N Blumenthaler; Rutika J Mehta; Sarah E Hoffe; Bruce D Minsky; Grace L Smith; Mariela Blum; Paul F Mansfield; Naruhiko Ikoma; Prajnan Das; Jaffer Ajani; Sean P Dineen; Jason B Fleming; Brian D Badgwell; Jose M Pimiento Journal: Ann Surg Date: 2021-10-01 Impact factor: 13.787
Authors: Astrid E Slagter; Edwin P M Jansen; Hanneke W M van Laarhoven; Johanna W van Sandick; Nicole C T van Grieken; Karolina Sikorska; Annemieke Cats; Pietje Muller-Timmermans; Maarten C C M Hulshof; Henk Boot; Maartje Los; Laurens V Beerepoot; Frank P J Peters; Geke A P Hospers; Boudewijn van Etten; Henk H Hartgrink; Mark I van Berge Henegouwen; Grard A P Nieuwenhuijzen; Richard van Hillegersberg; Donald L van der Peet; Heike I Grabsch; Marcel Verheij Journal: BMC Cancer Date: 2018-09-10 Impact factor: 4.430
Authors: Casey J Allen; Alisa N Blumenthaler; Prajnan Das; Bruce D Minsky; Mariela Blum; Sinchita Roy-Chowdhuri; Jaffer A Ajani; Naruhiko Ikoma; Paul F Mansfield; Brian D Badgwell Journal: World J Surg Oncol Date: 2020-02-17 Impact factor: 2.754