title: Morbidity, mortality, and pathological response in patients with gastric cancer preoperatively treated with chemotherapy or chemoradiotherapy.
abstract: BACKGROUND
  Significant tumor downstaging has been achieved in patients with localized gastric adenocarcinoma by preoperative chemoradiotherapy (ChRT) or induction chemotherapy (Ch). However the influence of ChRT and Ch on postoperative outcomes has not yet been clarified, with very few studies examining this issue. We retrospectively analyzed the efficacy in terms of pathological response and early postoperative complications of two protocols of preoperative ChRT and Ch for locally advanced gastric cancer.
  
  
  METHODS
  Between 2000 and 2008, 72 patients with operable locally advanced gastric cancer (cT3-4/N+) were treated with preoperative treatment: 1-patients receiving induction Ch or 2-neoadjuvant Ch followed by concurrent ChRT. Postoperative histopathological regression and surgical complications were investigated including variables related to patients, surgical variables, preoperative treatment, and tumor.
  
  
  RESULTS
  There were no differences in the incidence of complications between the ChRT and Ch groups (30.9% vs. 33.3%). The most frequent complications were nonspecific surgical complications (pneumonia [12.5%] and infection from intravenous catheters [9.7%]). Risk factors for complications were high-body mass index (BMI > 25 kg/m(2) ) and extension of surgery to the pancreas and spleen. A major pathological response was observed in 33.3% of patients, being more frequent in the ChRT group (47.6% vs. 13.3%; χ(2) , P = 0.0024).
  
  
  CONCLUSIONS
  Preoperative treatment with Ch or ChRT for locally advanced gastric cancer can be performed safely with an acceptable operative morbidity and low operative mortality rate with careful consideration of the added risk associated with BMI and surgical resection of the pancreas and spleen. Ch and ChRT is feasible and effective in terms of pathological response and R0 resection.
authors.affiliation: Department of Surgery, University of Navarre, Clinica Universidad de Navarra, Pamplona, Spain. vvalenti@unav.es
authors.forename: V
authors.initials: V
authors.lastname: Valenti
authors.forename: J L
authors.initials: JL
authors.lastname: Hernandez-Lizoaín
authors.forename: M C
authors.initials: MC
authors.lastname: Beorlegui
authors.forename: J A
authors.initials: JA
authors.lastname: Diaz-Gozalez
authors.forename: F M
authors.initials: FM
authors.lastname: Regueira
authors.forename: J J
authors.initials: JJ
authors.lastname: Rodriguez
authors.forename: A
authors.initials: A
authors.lastname: Viudez
authors.forename: I
authors.initials: I
authors.lastname: Sola
authors.forename: J A
authors.initials: JA
authors.lastname: Cienfuegos
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents