title: The effect of neoadjuvant radiation therapy on perioperative outcomes among patients undergoing resection of retroperitoneal sarcomas.
abstract: BACKGROUND
  Neoadjuvant radiation therapy (RT) has several theoretical benefits in the treatment of retroperitoneal sarcoma (RPS), but concerns remain about treatment toxicity and perioperative morbidity. There are limited data regarding its effect on perioperative outcomes, most of which come from small, single-institution series. The purpose of this study was to evaluate the short-term (30-day) postoperative morbidity and mortality associated with neoadjuvant RT following resection of RPS.
  
  
  METHODS
  The 2005-2011 National Surgical Quality Improvement Program Participant User File was queried for patients undergoing RPS resection. Subjects were stratified by use of neoadjuvant RT. Perioperative variables and short-term 30-day outcomes were compared. Groups were then propensity matched using a 2:1 nearest-neighbor algorithm and multivariable logistic regression was performed to assess neoadjuvant RT as a predictor of short-term 30-day outcomes.
  
  
  RESULTS
  A total of 785 patients were identified. Neoadjuvant RT was administered to 71 (9.0%). Patients who received neoadjuvant RT were slightly younger (56 vs. 62 years, p < 0.001), but otherwise the groups were similar. After propensity matching, all baseline characteristics were highly similar. Median operative time was longer in the neoadjuvant RT group (279 vs. 219 min, p < 0.01), but there were no differences in mortality (1.4 vs. 2.1%, p = 0.71), major complications (28.2 vs. 25.2%, p = 0.69), overall complications (35.2 vs.33.2%, p = 0.83), early reoperation (5.6 vs. 7.4%, p = 0.81), or length of stay (7 vs. 7 days, p = 0.56). Following further adjustment with logistic regression, we confirmed that there were no differences in 30-day mortality or morbidity between patients who did and did not receive neoadjuvant RT.
  
  
  CONCLUSIONS
  Neoadjuvant RT does not appear to increase short-term (30-day) morbidity or mortality following resection of RPS. Continued investigation is needed to better define the role for radiation therapy among patients with this disease.
authors.affiliation: Duke University, Department of Surgery, USA. Electronic address: daniel.nussbaum@duke.edu.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Nussbaum
authors.affiliation: Duke University, Department of Surgery, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.affiliation: Duke University, Department of Surgery, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Gulack
authors.affiliation: Duke University, Department of Surgery, USA.
authors.forename: Asvin M
authors.initials: AM
authors.lastname: Ganapathi
authors.affiliation: Duke University, Department of Surgery, USA.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Keenan
authors.affiliation: Duke University, Department of Biostatistics and Bioinformatics, USA.
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Stinnett
authors.affiliation: Duke University, Department of Radiation Oncology and Department of Pharmacology & Cancer Biology, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Kirsch
authors.affiliation: Duke University, Department of Surgery, USA.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
authors.affiliation: Duke University, Department of Surgery, USA.
authors.forename: Dan G
authors.initials: DG
authors.lastname: Blazer
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D061646:Operative Time; D011183:Postoperative Complications; D011184:Postoperative Period; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012186:Retroperitoneal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D016896:Treatment Outcome
keywords: 30-day outcomes; Neoadjuvant; Outcomes; Preoperative; Radiation therapy; Radiotherapy; Retroperitoneal sarcoma; Sarcoma; Short-term outcomes
references.citation: Ann Surg. 2009 Sep;250(3):363-76
references.pmid: 19644350
references.citation: Am J Clin Oncol. 2005 Jun;28(3):310-6
references.pmid: 15923806
references.citation: Ann Surg. 1998 Sep;228(3):355-65
references.pmid: 9742918
references.citation: Radiat Oncol. 2012 Dec 17;7:214
references.pmid: 23245199
references.citation: Ann Surg Oncol. 2007 Feb;14(2):583-90
references.pmid: 17094026
references.citation: Ann Surg Oncol. 2013 Jul;20(7):2140-7
references.pmid: 23392853
references.citation: ANZ J Surg. 2013 May;83(5):336-41
references.pmid: 22943678
references.citation: Curr Opin Oncol. 2007 Jul;19(4):359-66
references.pmid: 17545800
references.citation: Technol Cancer Res Treat. 2014 Jun;13(3):211-6
references.pmid: 23919397
references.citation: J Clin Oncol. 2013 May 1;31(13):1649-55
references.pmid: 23530096
references.citation: J Clin Oncol. 2000 Oct 1;18(19):3378-83
references.pmid: 11013278
references.citation: J Surg Oncol. 2014 May;109(6):606-11
references.pmid: 24374652
references.citation: Ann Surg Oncol. 2013 May;20(5):1494-9
references.pmid: 23242820
references.citation: Ann Surg Oncol. 2002 May;9(4):346-54
references.pmid: 11986186
references.citation: Radiother Oncol. 2014 Jan;110(1):165-71
references.pmid: 24411227
references.citation: J Oncol. 2008;2008:824036
references.pmid: 19277103
references.citation: Ann Surg Oncol. 2007 Jun;14(6):1787-9
references.pmid: 17406946
references.citation: Ann Surg Oncol. 2006 Apr;13(4):508-17
references.pmid: 16491338
references.citation: Ann Surg Oncol. 2007 Feb;14(2):577-82
references.pmid: 17119868