title: Impact of induction chemotherapy and preoperative chemoradiotherapy on operative morbidity and mortality in patients with locoregional adenocarcinoma of the stomach or gastroesophageal junction.
abstract: 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/m(2) 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.
authors.affiliation: Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Fujitani
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Crane
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
authors.forename: Peter W
authors.initials: PW
authors.lastname: Pisters
authors.forename: Nora
authors.initials: N
authors.lastname: Janjan
authors.forename: Garrett L
authors.initials: GL
authors.lastname: Walsh
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
authors.forename: David
authors.initials: D
authors.lastname: Rice
authors.forename: Angela
authors.initials: A
authors.lastname: Welch
authors.forename: Jackie
authors.initials: J
authors.lastname: Baker
authors.forename: Josephine
authors.initials: J
authors.lastname: Faust
authors.forename: Paul F
authors.initials: PF
authors.lastname: Mansfield
mesh_terms: D000232:Adenofibroma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004943:Esophagogastric Junction; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy