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Impact of the Interval Between Neoadjuvant Chemotherapy and Gastrectomy on Short- and Long-Term Outcomes for Patients with Advanced Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

A Correction to this article was published on 15 July 2021

This article has been updated

Abstract

Background

The optimal time between neoadjuvant chemotherapy (NAC) and gastrectomy for gastric cancer (GC) remains unknown. This study aimed to investigate the association between the time-to-surgery (TTS) interval and the major pathologic response (mPR).

Methods

In this study, 280 consecutive GC patients who underwent NAC followed by gastrectomy between 2014 and 2018 were retrospectively analyzed by the use of prospectively collected databases from three major GC treatment centers in Lithuania and Estonia. Based on TTS, they were grouped into three interval categories: the early-surgery group (ESG: ≤ 30 days; n = 70), the standard-surgery group (SSG: 31–43 days; n = 138), and the delayed-surgery group (DSG: ≥ 44 days, n = 72). The primary outcome of the study was the mPR rate. The secondary end points were postoperative morbidity, mortality, oncologic safety (measured as the number of resected lymph nodes and radicality), and long-term outcomes.

Results

The mPR rate for the ESG group (32.9%) was significantly higher than for the SSG group (20.3%) or the DSG group (16.7%) (p = 0.047). Furthermore, after adjustment for patient, tumor, and treatment characteristics, the odds for achievement of mPR were twofold higher for the patients undergoing early surgery (odds ratio [OR] 2.09; 95% conflidence interval [CI] 1.01–4.34; p = 0.047). Overall morbidity, severe complications, 30-day mortality, R0 resection, and retrieval of at least 15 lymph nodes rates were similar across the study groups. In addition, the long-term outcomes did not differ between the study groups.

Conclusions

This study suggests that an interval of no more than 30 days between the end of NAC and gastrectomy is associated with a higher mPR rate, the same oncologic safety of surgery, and similar morbidity and mortality.

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Acknowledgment

All data materials and analytical methods are available from the corresponding author upon a reasonable request.

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Authors and Affiliations

  1. Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

    Augustinas Bausys MD, Martynas Luksta MD, Rokas Rackauskas MD, PhD, Marius Kryzauskas MD, Rimantas Bausys MD, PhD & Kestutis Strupas MD, PhD

  2. Department of Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania

    Augustinas Bausys MD & Rimantas Bausys MD, PhD

  3. Upper Gastrointestinal Tract Surgery Department, North Estonia Medical Centre, Tallinn, Estonia

    Toomas Ümarik MD & Arvo Reinsoo MD

  4. Department of Medical Oncology, National Cancer Institute, Vilnius, Lithuania

    Giedre Anglickiene MD

  5. Pathology Department, North Estonia Medical Centre, Tallinn, Estonia

    Kristina Tõnismäe MD

  6. National Centre of Pathology, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania

    Veslava Senina MD & Dmitrij Seinin MD

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  1. Augustinas Bausys MD
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Correspondence to Augustinas Bausys MD.

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The original online version of this article has been revised: the Conclusions section of the Abstract was corrected.

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Bausys, A., Ümarik, T., Luksta, M. et al. Impact of the Interval Between Neoadjuvant Chemotherapy and Gastrectomy on Short- and Long-Term Outcomes for Patients with Advanced Gastric Cancer. Ann Surg Oncol 28, 4444–4455 (2021). https://doi.org/10.1245/s10434-020-09507-1

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