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Low Creatinine Clearance is a Risk Factor for D2 Gastrectomy after Neoadjuvant Chemotherapy

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The feasibility and safety of D2 surgery following neoadjuvant chemotherapy (NAC) has not been fully evaluated in patients with gastric cancer. Moreover, risk factor for surgical complications after D2 gastrectomy following NAC is also unknown. The purpose of the present study was to identify risk factors of postoperative complications after D2 surgery following NAC.

Methods

This study was conducted as an exploratory analysis of a prospective, randomized Phase II trial of NAC. The surgical complications were assessed and classified according to the Clavien–Dindo classification. A uni- and multivariate logistic regression analyses were performed to identify risk factors for morbidity.

Results

Among 83 patients who were registered to the Phase II trial, 69 patients received the NAC and D2 gastrectomy. Postoperative complications were identified in 18 patients and the overall morbidity rate was 26.1 %. The results of univariate and multivariate analyses of various factors for overall operative morbidity, creatinine clearance (CCr) ≤ 60 ml/min (P = 0.016) was identified as sole significant independent risk factor for overall morbidity. Occurrence of pancreatic fistula was significantly higher in the patients with a low CCr than in those with a high CCr.

Conclusions

Low CCr was a significant risk factor for surgical complications in D2 gastrectomy after NAC. Careful attention is required for these patients.

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Acknowledgment

The authors are grateful to Professor Morita of the Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine and Faculty of Medicine, Kyoto University, for his kind support for the statistical consideration and advice. This work is supported by Epidemiological & Clinical Research Information Network (ECRIN).

Conflict of interest

None declared.

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan

    Tsutomu Hayashi MD, Toru Aoyama MD, Takashi Ogata MD, Haruhiko Cho MD & Takaki Yoshikawa MD

  2. Department of Gastrointestinal Surgery, Hiroshima University, Hiroshima, Japan

    Kazuaki Tanabe MD

  3. Department of Surgery, Osaka General Medical Center, Osaka, Japan

    Kazuhiro Nishikawa MD

  4. Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan

    Yuichi Ito MD

  5. Department of Biostatistics and Epidemiology, Yokohama City University Medical Center, Yokohama, Japan

    Satoshi Morita PhD

  6. Data center, Nonprofit Organization ECRIN, Okazaki, Japan

    Yumi Miyashita

  7. Clinical Research Center, Shonan Kamakura General Hospital, Kamakura, Japan

    Akira Tsuburaya MD

  8. Tokai Central Hospital, Kakamigahara, Japan

    Junichi Sakamoto MD

Authors
  1. Tsutomu Hayashi MD
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  2. Toru Aoyama MD
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  3. Kazuaki Tanabe MD
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  4. Kazuhiro Nishikawa MD
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  5. Yuichi Ito MD
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  6. Takashi Ogata MD
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  7. Haruhiko Cho MD
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  8. Satoshi Morita PhD
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  9. Yumi Miyashita
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  10. Akira Tsuburaya MD
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  11. Junichi Sakamoto MD
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  12. Takaki Yoshikawa MD
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Corresponding author

Correspondence to Takaki Yoshikawa MD.

Additional information

Tsutomu Hayashi and Toru Aoyama have contributed equally to this work.

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Hayashi, T., Aoyama, T., Tanabe, K. et al. Low Creatinine Clearance is a Risk Factor for D2 Gastrectomy after Neoadjuvant Chemotherapy. Ann Surg Oncol 21, 3015–3022 (2014). https://doi.org/10.1245/s10434-014-3670-1

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  • DOI: https://doi.org/10.1245/s10434-014-3670-1

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