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PREOPERATIVE CHEMORADIATION THERAPY DOES NOT INCREASE RISK OF ANASTOMOTIC LEAK IN GASTRIC CANCER PATIENTS
Naruhiko Ikoma*, Mariela Blum, Jeannelyn Estrella, Keith Fournier, Paul Mansfield, Jaffer Ajani, Brian Badgwell
Univ. Texas MD Anderson Cancer Center, Houston, TX
Introduction:
Preoperative chemoradiation therapy is a safe and accepted treatment approach for esophageal and gastroesophageal junction (GEJ) cancer; however, little is known about the safety of this approach in gastric cancer patients. We sought to determine whether preoperative chemoradiation therapy increases the risk of anastomotic leak in gastric cancer patients without GEJ involvement.
Methods:
We reviewed data from a prospectively maintained database of gastric cancer patients who had undergone resection of gastric cancer at our institution between 2001 and 2006. Patients with recurrent disease, patients with tumors involving the GEJ, and patients who had undergone upfront gastrectomy because of symptoms (bleeding or obstruction) or age/comorbidities were excluded. Frequencies of anastomotic leak or symptomatic intra-abdominal fluid collections (IAF) were calculated by type of preoperative therapy, and the risk factors for anastomotic leak or IAF requiring intervention were examined by univariate and multivariate analyses.
Results:
We identified 358 patients (55% male; median age, 63 years) who had undergone resection of gastric cancer: 129 (36%) had undergone upfront surgery, 155 (43%) had received preoperative chemoradiation therapy (CXRT), and 74 (21%) had received preoperative chemotherapy. The upfront surgery group had more early EUS stage tumors (uT0-2 tumors; 82% vs. 14% in CXRT group and 12% in chemotherapy group; p<0.001), more early-treatment period tumors (2001-2008; 54% vs. 35% in CXRT group and 36% in chemotherapy group; p=0.002), and more limited lymph node dissections (D1 lymph node dissection; 35% vs 8% in CXRT group and 19% in chemotherapy group; p<0.001). Frequencies of clinically diagnosed anastomotic leak were 3% (4/129) in upfront surgery, 4% (6/155) in CXRT, and 3% (2/74) in chemotherapy groups (p=1.00); frequencies of IAF were 9% (11/129) in upfront surgery, 7% (11/155) in CXRT, and 5% (4/74) in chemotherapy groups (p=0.708). Postoperative 90-day mortalities were 0% (0/129) in upfront surgery, 1% (1/155) in CXRT, and 3% (2/74) in chemotherapy groups (p=0.156). Concomitant organ resection was the only risk factor for anastomotic leak or IAF requiring intervention by univariate and multivariate logistic regression analyses (odds ratio 3.80, 95% confidence interval 1.55-9.31; p=0.003). Type of preoperative therapy was not associated with anastomotic leak or IAF requiring intervention (p=0.607).
Conclusion:
Anastomotic leak or IAF was rare after gastrectomy, and neither preoperative CXRT nor preoperative chemotherapy was associated with increased risk of anastomotic leak or IAF in gastric cancer patients. Results from this study confirmed the safety profile of preoperative therapy, including preoperative radiation therapy, in terms of risk for anastomotic leak.
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