title: Comparative Investigation of Postoperative Complications in Patients With Gastroesophageal Junction Cancer Treated With Preoperative Chemotherapy or Surgery Alone.
abstract: OBJECTIVE
  Gastroesophageal junction cancer is one of the leading causes to cancer-related death and the prognosis is poor. However, progress has been made over the last couple of decades with the introduction of multimodality treatment and optimized surgery. Three-year survival rates have improved to 50% in patients receiving neoadjuvant therapy. Only a few studies have focused on the difference of postoperative complications in patients receiving neoadjuvant therapy in relation to a comparative surgery-only group. The aim of this study was to compare the prevalence of postoperative complications of patients with cancer at the gastroesophageal junction treated with either neoadjuvant chemotherapy or surgery alone in patients from "The Danish Clinical Registry of Carcinomas of the Esophagus, the Gastro-Esophageal Junction and the Stomach."
  
  
  METHODS
  A historical follow-up study, comparing postoperative complications between two cohorts before and after implementation of chemotherapy was completed.
  
  
  RESULTS
  In all, 180 consecutive patients treated with perioperative chemotherapy and a comparative surgery-only group of patients were identified from The Danish Clinical Registry of Carcinomas of the Esophagus, the Gastro-Esophageal Junction and the Stomach. No difference was found in demographics between the two groups, except for alcohol consumption and a lower T and N stage in the surgery-only group, and no difference in complication rates was found. Furthermore, no variable in the multivariate analysis was significantly associated with anastomotic leakage which was considered the most severe complication.
  
  
  CONCLUSIONS
  Since perioperative chemotherapy does not appear to increase surgical complications, the future challenges include defining the optimal combination of chemo- and/or radiotherapy, but more importantly also to select the patients who will benefit the most from the different neoadjuvant strategies.
authors: Department of Surgical Gastroenterology, Abdominalcentret, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark michael.patrick.achiam.01@regionh.dk.
authors: M P
authors: MP
authors: Achiam
authors: Department of Oncology, Finsencentret, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors: L B
authors: LB
authors: Jensen
authors: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors: H
authors: H
authors: Larsson
authors: Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
authors: L S
authors: LS
authors: Jensen
authors: Department of Gastrointestinal Surgery, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.
authors: A C
authors: AC
authors: Larsen
authors: Department of Surgical Gastroenterology, Abdominalcentret, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors: J
authors: J
authors: Holm
authors: Department of Surgical Gastroenterology, Abdominalcentret, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors: L B
authors: LB
authors: Svendsen
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols; D017024:Chemotherapy, Adjuvant; D003718:Denmark; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D016629:Esophagectomy; D004943:Esophagogastric Junction / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents
keywords: Gastroesophageal junction; adenocarcinoma; cancer; chemotherapy; neoadjuvant therapy; surgical complications