title: Neoadjuvant radiation therapy does not increase perioperative morbidity among patients undergoing gastrectomy for gastric cancer.
abstract: BACKGROUND
  Neoadjuvant radiation therapy (RT) as a component of the multimodality treatment of gastric cancer has demonstrated promising results. Data regarding its effect on perioperative safety are limited.
  
  
  METHODS
  Adults undergoing gastrectomy for gastric cancer in the 2005-2011 National Surgical Quality Improvement Program were included. Groups were defined by neoadjuvant RT use, and then propensity-matched based on preoperative variables. Multivariable logistic regression was performed to assess neoadjuvant RT as an independent predictor of outcomes.
  
  
  RESULTS
  Among 2,764 patients identified, 55 (2.0%) were treated with neoadjuvant RT. Patients who received neoadjuvant RT were more likely to have received preoperative chemotherapy and steroids, and experienced weight loss (all P < 0.01). After matching, however, there were no preoperative differences. At time of surgery, total (vs. partial) gastrectomy was more common among patients who underwent neoadjuvant RT (70.9 vs. 46.7%, P < 0.01), and operative time was longer (290 vs. 236 min, P < 0.01). There were no differences in overall complications (23.6 vs. 29.7%, P = 0.49) or 30-day mortality (3.6 vs. 3.6%, P = 0.99).
  
  
  CONCLUSIONS
  Neoadjuvant RT was not associated with increased morbidity or mortality following resection for gastric cancer. These findings support the ongoing investigation of neoadjuvant RT as part of the multidisciplinary management of resectable gastric cancer.
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina.
authors.forename: Zhifei
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Nussbaum
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.affiliation: Department of Radiation Oncology, Duke University, Durham, North Carolina.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Czito
authors.affiliation: Department of Surgery, University of Texas Medical Branch, Galveston, Texas.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina.
authors.forename: Dan G
authors.initials: DG
authors.lastname: Blazer
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D020360:Neoadjuvant Therapy / Q000401:mortality*; D009367:Neoplasm Staging; D059035:Perioperative Period; D011379:Prognosis; D011878:Radiotherapy / Q000401:mortality*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate
keywords: gastrectomy; gastric cancer; neoadjuvant radiation therapy; outcomes