Timing of Initiation of Adjuvant Chemotherapy for Gastric Cancer: A Case-Matched Comparison Study of Laparoscopic vs. Open Surgery

Publication date: Available online 29 January 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Akio Kaito, Takahiro Kinoshita, Kouhei Shitara, Hidehito Shibasaki, Toshirou Nishida
BackgroundLaparoscopic 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.MethodsThis 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.ResultsAC 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).ConclusionsLG may be associated with shorter intervals before AC. Postoperative morbidity should be reduced as much as possible.



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