title: Impact of Neoadjuvant Chemotherapy Among Patients with Pancreatic Fistula After Gastrectomy for Advanced Gastric Cancer.
abstract: BACKGROUND
  Neoadjuvant chemotherapy (NAC) has been widely adopted for patients with advanced gastric cancer; however, the safety of gastrectomy with D2 lymphadenectomy followed by NAC has not yet been evaluated. We retrospectively analyzed the influence of NAC on morbidity and mortality after gastrectomy in patients with advanced gastric cancer.
  
  
  METHODS
  A series of 364 patients with advanced gastric cancer who underwent gastrectomy without pancreatectomy between January 2008 and December 2010 at eight hospitals registered to the Yokohama Clinical Oncology Group were studied retrospectively. There were 330 patients who underwent surgical treatment immediately after diagnosis (surgery alone group) and 34 patients (NAC group) who first received NAC and then underwent surgical resection.
  
  
  RESULTS
  Although there were no significant differences in the morbidity rate between the two groups, postoperative pancreatic fistula was more often observed in NAC patients than in patients of the group treated with surgery alone [5 cases (14.7%) vs. 11 cases (3.3%); p=0.011]. In the univariate analysis, NAC (p=0.029), bursectomy (p<0.001) and operative bleeding (≥300 ml, p=0.002), were significantly correlated with postoperative pancreatic fistula, and NAC [odds ratio (OR)=4.901, 95% confidence interval (CI)=1.455-16.67; p=0.010] and bursectomy (OR=11.2, 95% CI=3.460-37.04; p<0.001) were independent risk factors for postoperative pancreatic fistula by multivariate analysis. The incidence of postoperative pancreatic fistula was 40.0% among patients who underwent gastrectomy with bursectomy followed by NAC.
  
  
  CONCLUSIONS
  The incidence of pancreatic fistula in patients treated with NAC and bursectomy was significantly higher than that in other patients. Bursectomy may be discouraged for the prevention of pancreatic fistula from gastrectomy following NAC.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan yokotaka1026@yahoo.co.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kosaka
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Akiyama
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
authors.forename: Hirochika
authors.initials: H
authors.lastname: Makino
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Kimura
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Takagawa
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
authors.forename: Hidetaka A
authors.initials: HA
authors.lastname: Ono
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan.
authors.forename: Chikara
authors.initials: C
authors.lastname: Kunisaki
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects* / Q000379:methods; D010185:Pancreatic Fistula / Q000188:drug therapy* / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Neoadjuvant chemotherapy; pancreatic fistula; surgical complication