title: Timing of initiation of adjuvant chemotherapy for gastric cancer: A case-matched comparison study of laparoscopic vs. open surgery.
abstract: BACKGROUND
  Laparoscopic gastrectomy (LG) is reported to be associated with faster recovery than open gastrectomy (OG); however, the influence of the surgical approach on initiation timing of adjuvant chemotherapy (AC) remains unclear.
  
  
  METHODS
  This was a single-institutional retrospective observational study. Patients with pathological stage II/III gastric cancer undergoing LG with D2 lymphadenectomy (LG group: n = 74) were matched 1:1 with patients selected from 214 similar patients undergoing OG (OG group: n = 74), identically matching gender, age, pathological stage, and type of gastrectomy, and comparing AC initiation timing between the two groups. Factors associated with delayed initiation of AC were investigated in a multivariable analysis.
  
  
  RESULTS
  AC was performed in 86.5% (LG) and 83.8% (OG) of patients (p = 0.64). The median time interval before AC was significantly shorter in the LG vs. OG group (5.7 vs. 6.6 weeks, respectively, p < 0.001), and significantly more patients received AC within 6 weeks (60.8% vs. 27.0%, p < 0.001). Independent factors associated with delayed initiation of AC (>6 weeks) were: morbidity (≥grade 3a; odds ratio (OR): 16.1, 95% confidence interval (CI): 1.86-143), open surgery (OR: 5.17, 95% CI: 2.50-13.1), and postoperative weight loss ≥ 8% (OR: 2.47, 95% CI: 1.07-5.71).
  
  
  CONCLUSIONS
  LG may be associated with shorter intervals before AC. Postoperative morbidity should be reduced as much as possible.
authors.affiliation: Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan. Electronic address: akaito@east.ncc.go.jp.
authors.forename: A
authors.initials: A
authors.lastname: Kaito
authors.affiliation: Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan. Electronic address: takkinos@east.ncc.go.jp.
authors.forename: T
authors.initials: T
authors.lastname: Kinoshita
authors.affiliation: Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan. Electronic address: kshitara@east.ncc.go.jp.
authors.forename: K
authors.initials: K
authors.lastname: Shitara
authors.affiliation: Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan. Electronic address: h-shibasaki@rb3.so-net.ne.jp.
authors.forename: H
authors.initials: H
authors.lastname: Shibasaki
authors.affiliation: Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan. Electronic address: tnishida@ncc.go.jp.
authors.forename: T
authors.initials: T
authors.lastname: Nishida
mesh_terms: D018784:Abdominal Abscess / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069287:Capecitabine; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives / Q000627:therapeutic use; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D010071:Oxaloacetates; D010094:Oxonic Acid / Q000008:administration & dosage; D010185:Pancreatic Fistula / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy*; D005641:Tegafur / Q000008:administration & dosage; D013997:Time Factors; D061665:Time-to-Treatment
chemical_list: D004338:Drug Combinations; D009944:Organoplatinum Compounds; D010071:Oxaloacetates; D000077150:Oxaliplatin; D003841:Deoxycytidine; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D000069287:Capecitabine; D002945:Cisplatin; D005472:Fluorouracil
keywords: Adjuvant chemotherapy; Case-control studies; Gastrectomy; Laparoscopy; Laparotomy; Stomach neoplasms