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Rawicz-Pruszyński K, Endo Y, Tsilimigras DI, Munir MM, Resende V, Kim A, Beane J, Pelc Z, Sędłak K, Pawlik TM. Neoadjuvant Chemotherapy Improves Oncological Outcomes and Long-Term Survival Among Elderly Patients with Locally Advanced Gastric Cancer: A Propensity Score Matched Analysis. Ann Surg Oncol 2024; 31:753-761. [PMID: 37985525 DOI: 10.1245/s10434-023-14569-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION In the USA, approximately half of newly diagnosed patients with GC are 75 years or older. The objective of the current population-based study was to investigate the impact of neoadjuvant chemotherapy (NAC) on the outcomes of elderly patients with locally advanced GC. PATIENTS AND METHODS Patients aged > 75 years were identified from the National Cancer Database (NCDB). The primary outcome of the study was overall survival (OS). Secondary outcomes included lymph node (LN) harvest, surgical margin status, and 30-day mortality. To minimize the effect of selection bias on the assessed outcome between the two study groups (NAC versus no NAC), propensity score matching (PSM) was performed. RESULTS After PSM, a total of 1958 patients were included in both groups. NAC utilization increased from 2013 to 2019 (21% versus 42.7%, ptrend < 0.001). On pathologic analysis, patients who received NAC were more likely to have ≥ 16 LNs evaluated (NAC 60.1% versus no NAC 55.5%, p = 0.044) and negative resection margins (NAC 88.6% versus no NAC 83%, p = 0.001). Patients who received NAC were also less likely to experience 30-day mortality following resection (NAC 4.1% versus no NAC 7.1%). Receipt of NAC was associated with improved 1-year (73.9% versus 68.3%), 3-year (48.2% versus 43.5%), and 5-year OS (36.9% versus 30.5%) compared with patients who underwent upfront surgery (p = 0.01). CONCLUSIONS Receipt of NAC was associated with improved oncological outcomes among elderly patients undergoing resection for locally advanced GC.
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Affiliation(s)
- Karol Rawicz-Pruszyński
- Department of Surgery,The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Wexner Medical Center , Columbus, OH, USA
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Yutaka Endo
- Department of Surgery,The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Wexner Medical Center , Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Department of Surgery,The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Wexner Medical Center , Columbus, OH, USA
| | - Muhammad Musaab Munir
- Department of Surgery,The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Wexner Medical Center , Columbus, OH, USA
| | - Vivian Resende
- Department of Surgery,The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Wexner Medical Center , Columbus, OH, USA
- Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | - Alex Kim
- Department of Surgery,The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Wexner Medical Center , Columbus, OH, USA
| | - Joal Beane
- Department of Surgery,The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Wexner Medical Center , Columbus, OH, USA
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Timothy M Pawlik
- Department of Surgery,The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Wexner Medical Center , Columbus, OH, USA.
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Jehan FS, Pandit V, Khreiss M, Joseph B, Aziz H. Frailty Predicts Loss of Independence After Liver Surgery. J Gastrointest Surg 2022; 26:2496-2502. [PMID: 36344796 DOI: 10.1007/s11605-022-05513-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Loss of independence (LOI) is a significant concern in patients undergoing liver surgery. Although the risks of morbidity and mortality have been well studied, there is a dearth of data regarding the risk of LOI. Therefore, this study aimed to assess predictors of LOI after liver surgery. METHODS This study utilized the National Surgical Quality Improvement Program (NSQIP) data from 2015 to 2018 from a retrospective cohort study of patients undergoing liver resections. LOI was defined as the change from preoperative functional independence to the postoperative discharge requirement in a post-care facility. Frailty was defined using the modified frailty index-5 (mFI-5). RESULTS A total of 22,463 patients underwent hepatectomy via the NSQIP during the study period. In total, 22,067 participants were included in the analysis. A total of 4.7% of patients had LOI after surgery and were discharged to a rehabilitation center or nursing facility. mFI-1 was an independent predictor of LOI (OR:2.2 [1.9-4.3]). However, the odds for LOI were higher (OR:5.1[2.5-8.2]) in patients with mFI ≥ 2. CONCLUSION LOI is an important outcome of liver surgery. Frailty is a predictor of LOI and should be used as a guide to inform patients about the potential outcomes.
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Affiliation(s)
- Faisal S Jehan
- Department of Surgery, Westchester Medical Center-New York Medical College, Valhalla, NY, USA
| | - Viraj Pandit
- Department of Surgery, Fresno VA Medical Center, Fresno, CA, USA
| | | | - Bellal Joseph
- Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Hassan Aziz
- Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, C41-S GH, IA, 52242, Iowa City, USA.
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