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Journal of Gastrointestinal Surgery

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01-06-2020 | Gastrectomy | Original Article

Effects of Neoadjuvant Chemotherapy Toxicity and Postoperative Complications on Short-term and Long-term Outcomes After Curative Resection of Gastric Cancer

Authors: Chaorui Wu, Nianchang Wang, Hong Zhou, Tongbo Wang, Qikun Mao, Xiaojie Zhang, Dongbing Zhao

Published in: Journal of Gastrointestinal Surgery | Issue 6/2020

Abstract

Background

Whether neoadjuvant chemotherapy (NAC) increased the risk of postoperative morbidities for patients with locally advanced gastric cancer (GC) is unknown. Whether neoadjuvant chemotherapy toxicity (NCT) and postoperative complications (POCs) correlate with short-term and long-term outcomes also remains unclear. We aimed to evaluate the role of NAC on the development of POCs, as well as the impact of NCT and POCs on postoperative and oncologic outcomes in curatively resected GC treated with NAC.

Methods

This study retrospectively reviewed 230 patients who underwent curative gastrectomy for locally advanced GC (clinically T3/4 or N+) after NAC between 2006 and 2016. Five hundred patients undergoing upfront and curative surgery were selected as a control group. After matching, the incidence of POCs was compared between two groups. In the NAC group, clinicopathological characteristics of patients who experienced POCs were compared to those who did not. Logistic and Cox multivariate regression analyses were used to examine factors associated with POCs, disease-free survival (DFS), and overall survival (OS).

Results

Following matching, 230 and 230 patients treated with surgery plus NAC and upfront surgery remained, respectively. The incidence of POCs was 28.7% and 24.3%, respectively (p = 0.290). In the NAC group, NCT (OR [odds ratio] 22.968, 95% CI [confidence interval] 2.948–> 99, p = 0.003) and operation time (OR 1.006, 95% CI 1.001–1.011, p = 0.021) were independent predictive factors of POCs. NCT did not affect oncologic outcomes. The Cox regression model demonstrated that POCs were independently associated with worse DFS (HR [hazard ratio] 2.128, 95% CI 1.240–3.653, p = 0.006) but not OS for patients treated with NAC.

Conclusions

The administration of NAC is not associated with an elevated risk of POCs. For patients treated with NAC, NCT is an independent predictor of POCs, but does not affect oncologic outcomes. POCs is independently associated with worse DFS but not OS. NAC should be considered a safe approach in patients who have locally advanced GC. Strategies to minimize chemotherapy toxicity and postoperative morbidities associated with NAC are warranted.

F. Bray, J. Ferlay, I. Soerjomataram, R.L. Siegel, L.A. Torre, A. Jemal, Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries., CA. Cancer J. Clin. (2018). doi:https://doi.org/10.3322/caac.21492.

S.H. Noh, S.R. Park, H.-K. Yang, H.C. Chung, I.-J. Chung, S.-W. Kim, H.-H. Kim, J.-H. Choi, H.-K. Kim, W. Yu, J.I. Lee, D.B. Shin, J. Ji, J.-S. Chen, Y. Lim, S. Ha, Y.-J. Bang, Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised phase 3 trial., Lancet. Oncol. 15 (2014) 1389–1396. doi:https://doi.org/10.1016/S1470-2045(14)70473-5.CrossRefPubMed

A. Ruol, G. Portale, C. Castoro, S. Merigliano, M. Cagol, F. Cavallin, V. Chiarion Sileni, L. Corti, S. Rampado, M. Costantini, E. Ancona, Effects of neoadjuvant therapy on perioperative morbidity in elderly patients undergoing esophagectomy for esophageal cancer., Ann. Surg. Oncol. 14 (2007) 3243–3250. doi:https://doi.org/10.1245/s10434-007-9455-z.CrossRefPubMed

W.B. Robb, M. Messager, D. Goere, V. Pichot-Delahaye, J.H. Lefevre, D. Louis, J. Guiramand, K. Kraft, C. Mariette, J.P. Arnaud, D. Brachet, J.M. Balon, S. Fabre, F. Borie, M. Prudhomme, C. Brigand, M. Fernandez, N. Carrere, X.B. D’Journo, P.A. Thomas, P. Dechelotte, J.R. Delpero, A. Dhari, J.M. Regimbeau, R. Flamein, B. Gillet, B. Mathieu, D. Pezet, A. Glaise, B. Millat, O. Glehen, D. Goéré, A. Souadka, M. Guilbert, A. Poisson, F. Vandois, N. Huten, F. Paye, E. Leteurtre, J.Y. Mabrut, B. Meunier, T. Thiébot, S. Michalak, F. Michot, B. Tsilividis, F. Peschaud, M. Pocard, Predictive factors of postoperative mortality after junctional and gastric adenocarcinoma resection, JAMA Surg. 148 (2013) 624–631. doi:https://doi.org/10.1001/jamasurg.2013.63. CrossRefPubMed

W.B. Robb, M. Messager, C. Gronnier, W. Tessier, F. Hec, G. Piessen, C. Mariette, High-Grade Toxicity to Neoadjuvant Treatment for Upper Gastrointestinal Carcinomas: What is the Impact on Perioperative and Oncologic Outcomes?, Ann. Surg. Oncol. 22 (2015) 3632–3639. doi:https://doi.org/10.1245/s10434-015-4423-5.CrossRefPubMed

A.N. Martin, D. Das, F.E. Turrentine, T.W. Bauer, R.B. Adams, V.M. Zaydfudim, Morbidity and Mortality After Gastrectomy: Identification of Modifiable Risk Factors., J. Gastrointest. Surg. 20 (2016) 1554–1564. doi:https://doi.org/10.1007/s11605-016-3195-y.CrossRefPubMedPubMedCentral

E.K. Bartlett, R.E. Roses, R.R. Kelz, J.A. Drebin, D.L. Fraker, G.C. Karakousis, Morbidity and mortality after total gastrectomy for gastric malignancy using the American College of Surgeons National Surgical Quality Improvement Program database., Surgery. 156 (2014) 298–304. doi:https://doi.org/10.1016/j.surg.2014.03.022.CrossRefPubMed

Y.H.M. Claassen, H.H. Hartgrink, J.L. Dikken, W.O. de Steur, J.W. van Sandick, N.C.T. van Grieken, A. Cats, A.K. Trip, E.P.M. Jansen, W.M. Meershoek-Klein Kranenbarg, J.P.B.M. Braak, H. Putter, M.I. van Berge Henegouwen, M. Verheij, C.J.H. van de Velde, Surgical morbidity and mortality after neoadjuvant chemotherapy in the CRITICS gastric cancer trial., Eur. J. Surg. Oncol. 44 (2018) 613–619. doi:https://doi.org/10.1016/j.ejso.2018.02.004.CrossRefPubMed

K.-K. Li, Y.-J. Wang, X.-H. Liu, Q.-Y. Tan, Y.-G. Jiang, W. Guo, The effect of postoperative complications on survival of patients after minimally invasive esophagectomy for esophageal cancer., Surg. Endosc. 31 (2017) 3475–3482. doi:https://doi.org/10.1007/s00464-016-5372-1.CrossRefPubMed

10.

Z. Li, B. Bai, Y. Zhao, D. Yu, B. Lian, Y. Liu, Q. Zhao, Severity of complications and long-term survival after laparoscopic total gastrectomy with D2 lymph node dissection for advanced gastric cancer: A propensity score-matched, case-control study., Int. J. Surg. 54 (2018) 62–69. doi:https://doi.org/10.1016/j.ijsu.2018.04.034.CrossRefPubMed

11.

N. Jiang, J.-Y. Deng, X.-W. Ding, L. Zhang, H.-G. Liu, Y.-X. Liang, H. Liang, Effect of complication grade on survival following curative gastrectomy for carcinoma., World J. Gastroenterol. 20 (2014) 8244–8252. doi:https://doi.org/10.3748/wjg.v20.i25.8244.CrossRefPubMedPubMedCentral

12.

A. Artinyan, S.T. Orcutt, D.A. Anaya, P. Richardson, G.J. Chen, D.H. Berger, Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients., Ann. Surg. 261 (2015) 497–505. doi:https://doi.org/10.1097/SLA.0000000000000854.CrossRefPubMed

13.

L.X. Jin, D.E. Sanford, M.H. 3rd Squires, L.E. Moses, Y. Yan, G.A. Poultsides, K.I. Votanopoulos, S.M. Weber, M. Bloomston, T.M. Pawlik, W.G. Hawkins, D.C. Linehan, C. Schmidt, D.J. Worhunsky, A.W. Acher, K. Cardona, C.S. Cho, D.A. Kooby, E.A. Levine, E. Winslow, N. Saunders, G. Spolverato, G.A. Colditz, S.K. Maithel, R.C. Fields, Interaction of Postoperative Morbidity and Receipt of Adjuvant Therapy on Long-Term Survival After Resection for Gastric Adenocarcinoma: Results From the U.S. Gastric Cancer Collaborative., Ann. Surg. Oncol. 23 (2016) 2398–2408. doi:https://doi.org/10.1245/s10434-016-5121-7.CrossRefPubMed

14.

R.P. Merkow, D.J. Bentrem, M.F. Mulcahy, J.W. Chung, D.E. Abbott, T.E. Kmiecik, A.K. Stewart, D.P. Winchester, C.Y. Ko, K.Y. Bilimoria, Effect of postoperative complications on adjuvant chemotherapy use for stage III colon cancer., Ann. Surg. 258 (2013) 847–853. doi:https://doi.org/10.1097/SLA.0000000000000312.CrossRefPubMed

15.

R.P. Merkow, K.Y. Bilimoria, J.S. Tomlinson, J.L. Paruch, J.B. Fleming, M.S. Talamonti, C.Y. Ko, D.J. Bentrem, Postoperative complications reduce adjuvant chemotherapy use in resectable pancreatic cancer., Ann. Surg. 260 (2014) 372–377. doi:https://doi.org/10.1097/SLA.0000000000000378.CrossRefPubMed

16.

K.A. Cavassani, W.F. 4th Carson, A.P. Moreira, H. Wen, M.A. Schaller, M. Ishii, D.M. Lindell, Y. Dou, N.W. Lukacs, V.G. Keshamouni, C.M. Hogaboam, S.L. Kunkel, The post sepsis-induced expansion and enhanced function of regulatory T cells create an environment to potentiate tumor growth., Blood. 115 (2010) 4403–4411. doi:https://doi.org/10.1182/blood-2009-09-241083.CrossRefPubMedPubMedCentral

17.

R.S. Hotchkiss, G. Monneret, D. Payen, Sepsis-induced immunosuppression: from cellular dysfunctions to immunotherapy., Nat. Rev. Immunol. 13 (2013) 862–874. doi:https://doi.org/10.1038/nri3552.CrossRefPubMedPubMedCentral

18.

K. Eto, N. Hiki, K. Kumagai, Y. Shoji, Y. Tsuda, Y. Kano, I. Yasufuku, Y. Okumura, M. Tsujiura, S. Ida, S. Nunobe, M. Ohashi, T. Sano, T. Yamaguchi, Prophylactic effect of neoadjuvant chemotherapy in gastric cancer patients with postoperative complications, Gastric Cancer. 21 (2018) 703–709. doi:https://doi.org/10.1007/s10120-017-0781-y.CrossRefPubMed

19.

D. Vicente, N. Ikoma, Y.J. Chiang, K. Fournier, C.W.D. Tzeng, S. Song, P. Mansfield, J. Ajani, B.D. Badgwell, Preoperative Therapy for Gastric Adenocarcinoma is Protective for Poor Oncologic Outcomes in Patients with Complications After Gastrectomy, Ann. Surg. Oncol. 25 (2018) 2720–2730. doi:https://doi.org/10.1245/s10434-018-6638-8.CrossRefPubMed

20.

Japanese gastric cancer treatment guidelines 2014 (ver. 4)., Gastric Cancer. 20 (2017) 1–19. doi:https://doi.org/10.1007/s10120-016-0622-4.

21.

R. Langer, K. Becker, Tumor regression grading of gastrointestinal cancers after neoadjuvant therapy., Virchows Arch. 472 (2018) 175–186. doi:https://doi.org/10.1007/s00428-017-2232-x.CrossRefPubMed

22.

E.A. Eisenhauer, P. Therasse, J. Bogaerts, L.H. Schwartz, D. Sargent, R. Ford, J. Dancey, S. Arbuck, S. Gwyther, M. Mooney, L. Rubinstein, L. Shankar, L. Dodd, R. Kaplan, D. Lacombe, J. Verweij, New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)., Eur. J. Cancer. 45 (2009) 228–247. doi:https://doi.org/10.1016/j.ejca.2008.10.026.CrossRefPubMed

23.

National Cancer Institute, Common Terminology Criteria for Adverse Events (CTCAE),Version 4.0, (n.d.). http://evs.nci.nih.gov/%0Aftp1/CTCAE/CTCAE_ 4.03_2010-06-14_QuickReference_5x7.pdf.

24.

D. Dindo, N. Demartines, P.-A. Clavien, Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey., Ann. Surg. 240 (2004) 205–213.CrossRefPubMedPubMedCentral

25.

R.B.J. D’Agostino, Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group., Stat. Med. 17 (1998) 2265–2281.CrossRefPubMed

26.

H.S. Ahn, S.H. Jeong, Y.G. Son, H.J. Lee, S.A. Im, Y.J. Bang, H.H. Kim, H.K. Yang, Effect of neoadjuvant chemotherapy on postoperative morbidity and mortality in patients with locally advanced gastric cancer, Br. J. Surg. 101 (2014) 1560–1565. doi:https://doi.org/10.1002/bjs.9632.CrossRefPubMed

27.

F. Coccolini, M. Nardi, G. Montori, M. Ceresoli, A. Celotti, S. Cascinu, P. Fugazzola, M. Tomasoni, O. Glehen, F. Catena, Y. Yonemura, L. Ansaloni, Neoadjuvant chemotherapy in advanced gastric and esophago-gastric cancer. Meta-analysis of randomized trials., Int. J. Surg. 51 (2018) 120–127. doi:https://doi.org/10.1016/j.ijsu.2018.01.008.CrossRefPubMed

28.

D. Cunningham, W.H. Allum, S.P. Stenning, J.N. Thompson, C.J.H. Van de Velde, M. Nicolson, J.H. Scarffe, F.J. Lofts, S.J. Falk, T.J. Iveson, D.B. Smith, R.E. Langley, M. Verma, S. Weeden, Y.J. Chua, M.T. Participants, Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer., N. Engl. J. Med. 355 (2006) 11–20. doi:https://doi.org/10.1056/NEJMoa055531.CrossRefPubMed

29.

M. Ychou, V. Boige, J.P. Pignon, T. Conroy, O. Bouché, G. Lebreton, M. Ducourtieux, L. Bedenne, J.M. Fabre, B. Saint-Aubert, J. Genève, P. Lasser, P. Rougier, Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: An FNCLCC and FFCD multicenter phase III trial, J. Clin. Oncol. 29 (2011) 1715–1721. doi:https://doi.org/10.1200/JCO.2010.33.0597.CrossRefPubMed

30.

K.M. Sjoquist, B.H. Burmeister, B.M. Smithers, J.R. Zalcberg, R.J. Simes, A. Barbour, V. Gebski, Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis., Lancet. Oncol. 12 (2011) 681–692. doi:https://doi.org/10.1016/S1470-2045(11)70142-5.CrossRefPubMed

31.

B.H.L. Tan, K. Brammer, N. Randhawa, N.T. Welch, S.L. Parsons, E.J. James, J.A. Catton, Sarcopenia is associated with toxicity in patients undergoing neo-adjuvant chemotherapy for oesophago-gastric cancer., Eur. J. Surg. Oncol. 41 (2015) 333–338. doi:https://doi.org/10.1016/j.ejso.2014.11.040.CrossRefPubMed

32.

C. Simonsen, P. de Heer, E.D. Bjerre, C. Suetta, P. Hojman, B.K. Pedersen, L.B. Svendsen, J.F. Christensen, Sarcopenia and Postoperative Complication Risk in Gastrointestinal Surgical Oncology: A Meta-analysis., Ann. Surg. 268 (2018) 58–69. doi:https://doi.org/10.1097/SLA.0000000000002679.CrossRefPubMed

33.

S.S. Shachar, G.R. Williams, H.B. Muss, T.F. Nishijima, Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis and systematic review., Eur. J. Cancer. 57 (2016) 58–67. doi:https://doi.org/10.1016/j.ejca.2015.12.030.CrossRefPubMed

34.

K. Furukawa, T. Irino, R. Makuuchi, Y. Koseki, K. Nakamura, Y. Waki, Impact of preoperative wait time on survival in patients with clinical stage II / III gastric cancer, (2018). doi:https://doi.org/10.1007/s10120-018-00910-y.

35.

H.J.F. Brenkman, E. Visser, P.S.N. Van Rossum, S. Siesling, Association Between Waiting Time from Diagnosis to Treatment and Survival in Patients with Curable Gastric Cancer : A Population-Based Study in the Netherlands, (2017) 1761–1769. doi:https://doi.org/10.1245/s10434-017-5820-8.

36.

A. Cuschieri, P. Fayers, J. Fielding, J. Craven, J. Bancewicz, V. Joypaul, P. Cook, Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group., Lancet (London, England). 347 (1996) 995–999.CrossRef

37.

T. Sano, M. Sasako, S. Yamamoto, A. Nashimoto, A. Kurita, M. Hiratsuka, T. Tsujinaka, T. Kinoshita, K. Arai, Y. Yamamura, K. Okajima, Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy--Japan Clinical Oncology Group study 9501., J. Clin. Oncol. 22 (2004) 2767–2773. doi:https://doi.org/10.1200/JCO.2004.10.184.CrossRefPubMed

38.

J. Zhou, P. Yu, Y. Shi, B. Tang, Y. Hao, Y. Zhao, F. Qian, Evaluation of Clavien-Dindo classification in patients undergoing total gastrectomy for gastric cancer., Med. Oncol. 32 (2015) 120. doi:https://doi.org/10.1007/s12032-015-0573-3.CrossRefPubMed

39.

H.J.F. Brenkman, S.S. Gisbertz, A.E. Slaman, L. Goense, J.P. Ruurda, M.I. van Berge Henegouwen, R. van Hillegersberg, Postoperative Outcomes of Minimally Invasive Gastrectomy Versus Open Gastrectomy During the Early Introduction of Minimally Invasive Gastrectomy in the Netherlands: A Population-based Cohort Study., Ann. Surg. 266 (2017) 831–838. doi:https://doi.org/10.1097/SLA.0000000000002391.CrossRefPubMed

40.

M. Tokunaga, Y. Tanizawa, E. Bando, T. Kawamura, M. Terashima, Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer., Ann. Surg. Oncol. 20 (2013) 1575–1583. doi:https://doi.org/10.1245/s10434-012-2720-9.CrossRefPubMed

41.

T. Eguchi, Y. Kodera, H. Nakanishi, H. Yokoyama, N. Ohashi, Y. Ito, G. Nakayama, M. Koike, M. Fujiwara, A. Nakao, The effect of chemotherapy against micrometastases and isolated tumor cells in lymph nodes: an in vivo study., In Vivo. 22 (2008) 707–712.PubMed

42.

T. Kubota, N. Hiki, T. Sano, S. Nomura, S. Nunobe, K. Kumagai, S. Aikou, R. Watanabe, T. Kosuga, T. Yamaguchi, Prognostic significance of complications after curative surgery for gastric cancer., Ann. Surg. Oncol. 21 (2014) 891–898. doi:https://doi.org/10.1245/s10434-013-3384-9.CrossRefPubMed

43.

K. Sakurai, N. Kubo, T. Tamura, T. Toyokawa, R. Amano, H. Tanaka, K. Muguruma, M. Yashiro, K. Maeda, K. Hirakawa, M. Ohira, Adverse Effects of Low Preoperative Skeletal Muscle Mass in Patients Undergoing Gastrectomy for Gastric Cancer., Ann. Surg. Oncol. 24 (2017) 2712–2719. doi:https://doi.org/10.1245/s10434-017-5875-6.CrossRefPubMed

44.

D. Tamandl, M. Paireder, R. Asari, P.A. Baltzer, S.F. Schoppmann, A. Ba-Ssalamah, Markers of sarcopenia quantified by computed tomography predict adverse long-term outcome in patients with resected oesophageal or gastro-oesophageal junction cancer., Eur. Radiol. 26 (2016) 1359–1367. doi:https://doi.org/10.1007/s00330-015-3963-1.CrossRefPubMed

45.

S. Lorenzen, B. Panzram, R. Rosenberg, H. Nekarda, K. Becker, U. Schenk, H. Hofler, J.-R. Siewert, D. Jager, K. Ott, Prognostic significance of free peritoneal tumor cells in the peritoneal cavity before and after neoadjuvant chemotherapy in patients with gastric carcinoma undergoing potentially curative resection., Ann. Surg. Oncol. 17 (2010) 2733–2739. doi:https://doi.org/10.1245/s10434-010-1090-4. Author names in bold designate shared co-first authorship.CrossRefPubMed

46.

S. Yamashita, R.A. Sheth, A.S. Niekamp, T.A. Aloia, Y.S. Chun, J.E. Lee, J.-N. Vauthey, C. Conrad, Comprehensive Complication Index Predicts Cancer-specific Survival After Resection of Colorectal Metastases Independent of RAS Mutational Status., Ann. Surg. 266 (2017) 1045–1054. doi:https://doi.org/10.1097/SLA.0000000000002018.CrossRefPubMed

47.

N. Dirican, Y.A. Karakaya, S. Gunes, F.T. Daloglu, A. Dirican, Association of intra-tumoral tumour-infiltrating lymphocytes and neutrophil-to-lymphocyte ratio is an independent prognostic factor in non-small cell lung cancer., Clin. Respir. J. 11 (2017) 789–796. doi:https://doi.org/10.1111/crj.12417.CrossRefPubMed

48.

C.-Y. Ock, A.-R. Nam, J. Lee, J.-H. Bang, K.-H. Lee, S.-W. Han, T.-Y. Kim, S.-A. Im, T.-Y. Kim, Y.-J. Bang, D.-Y. Oh, Prognostic implication of antitumor immunity measured by the neutrophil-lymphocyte ratio and serum cytokines and angiogenic factors in gastric cancer., Gastric Cancer. 20 (2017) 254–262. doi:https://doi.org/10.1007/s10120-016-0613-5.CrossRefPubMed

49.

E. Lieto, G. Galizia, A. Auricchio, F. Cardella, A. Mabilia, N. Basile, G. Del Sorbo, P. Castellano, C. Romano, M. Orditura, V. Napolitano, Preoperative Neutrophil to Lymphocyte Ratio and Lymphocyte to Monocyte Ratio are Prognostic Factors in Gastric Cancers Undergoing Surgery., J. Gastrointest. Surg. 21 (2017) 1764–1774. doi:https://doi.org/10.1007/s11605-017-3515-x.CrossRefPubMed

50.

H. Tanaka, T. Tamura, T. Toyokawa, K. Muguruma, Y. Miki, N. Kubo, K. Sakurai, K. Hirakawa, M. Ohira, Clinical Relevance of Postoperative Neutrophil-Lymphocyte Ratio (NLR) to Recurrence After Adjuvant Chemotherapy of S-1 for Gastric Cancer., Anticancer Res. 38 (2018) 3745–3751. doi:https://doi.org/10.21873/anticanres.12655.CrossRefPubMed

51.

G.L. Baiocchi, D. Marrelli, G. Verlato, P. Morgagni, S. Giacopuzzi, A. Coniglio, A. Marchet, F. Rosa, M.G. Capponi, A. Di Leo, L. Saragoni, L. Ansaloni, F. Pacelli, D. Nitti, D. D’Ugo, F. Roviello, G.A.M. Tiberio, S.M. Giulini, G. De Manzoni, Follow-up after gastrectomy for cancer: an appraisal of the Italian research group for gastric cancer., Ann. Surg. Oncol. 21 (2014) 2005–2011. doi:https://doi.org/10.1245/s10434-014-3534-8.CrossRefPubMed

Title: Effects of Neoadjuvant Chemotherapy Toxicity and Postoperative Complications on Short-term and Long-term Outcomes After Curative Resection of Gastric Cancer
Authors: Chaorui Wu
Nianchang Wang
Hong Zhou
Tongbo Wang
Qikun Mao
Xiaojie Zhang
Dongbing Zhao
Publication date: 01-06-2020
Publisher: Springer US
Keywords: Gastrectomy
Gastric Cancer
Gastric Cancer
Gastrectomy
Cytostatic Therapy
Published in: Journal of Gastrointestinal Surgery / Issue 6/2020
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-019-04257-2

At a glance: The STEP trials

Springer Medicine

Effects of Neoadjuvant Chemotherapy Toxicity and Postoperative Complications on Short-term and Long-term Outcomes After Curative Resection of Gastric Cancer

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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