Intraoperative blood loss as an independent prognostic factor for curative resection after neoadjuvant chemotherapy for
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ORIGINAL ARTICLE
Intraoperative blood loss as an independent prognostic factor for curative resection after neoadjuvant chemotherapy for gastric cancer: a single‑center retrospective cohort study Masato Hayashi1 · Takaki Yoshikawa1 · Masahiro Yura1 · Sho Otsuki1 · Yukinori Yamagata1 · Shinji Morita1 · Hitoshi Katai1 · Toshirou Nishida1 Received: 18 April 2020 / Accepted: 14 July 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose Surgery-induced factors such as postoperative infectious complications (PICs) and intraoperative blood loss (IBL) have a negative impact on the survival of patients undergoing surgery for gastric cancer. A recent study showed that neoadjuvant chemotherapy (NAC) could reduce the negative impact of PICs; hence, we conducted the present study to investigate if NAC can also reduce the negative prognostic impact of IBL. Methods We reviewed 115 gastric cancer patients treated with NAC and radical gastrectomy. The cut-off for IBL predicting the long-term survival was assessed by a receiver operating characteristic curve. The Cox proportional hazard model was used to evaluate the association between patient characteristics including IBL, overall survival, and disease-free survival. Results The cut-off for IBL was set at 990 ml. Twenty-six patients had excessive IBL exceeding 990 ml (22.6%) and PICs developed in 33 patients (28.7%). The body mass index, IBL, ypT, and ypN were significant independent prognostic predictors, but PICs were not. Conclusion NAC did not decrease the risk induced by excessive IBL. The prophylactic effect of NAC on surgery-induced risk was inconsistent. Keywords Gastric cancer · Neoadjuvant chemotherapy · Blood loss
Introduction Gastric cancer is the fourth-most common cancer in the world [1]. While the prognosis of treated early gastric cancer is excellent, that of advanced gastric cancer remains poor, even after radical gastrectomy and adjuvant chemotherapy. Neoadjuvant chemotherapy (NAC) may improve the prognosis of patients with advanced gastric cancer [2–7]. NAC has several benefits over postoperative adjuvant chemotherapy, especially in that it eradicates invisible micrometastases present in the blood or other organs before surgery for the Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00595-020-02114-3) contains supplementary material, which is available to authorized users. * Takaki Yoshikawa [email protected] 1
Department of Gastric Surgery, National Cancer Center Hospital, 5‑1‑1 Tsukiji, Chuo‑ku, Tokyo 104‑0045, Japan
primary tumor [3, 5]. Furthermore, a recent study found that NAC was able to negate the negative impact of postoperative infectious complications (PICs) on the survival of advanced gastric cancer patients [8]. Primary surgery carries risks beyond postoperative complications, which can lead to a poor outcome. Several studies have identified strong relationships between poor survival and excessive intraoperative blood loss (IBL) in gastric cancer patients [9–14]. Although the
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