s-1-(combination) and Pancreatic-Fistula

Laparoscopic 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.. This 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.. AC 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).. LG may be associated with shorter intervals before AC. Postoperative morbidity should be reduced as much as possible.

Topics: Abdominal Abscess; Adult; Aged; Aged, 80 and over; Anastomotic Leak; Antineoplastic Combined Chemotherapy Protocols; Capecitabine; Case-Control Studies; Chemotherapy, Adjuvant; Cisplatin; Deoxycytidine; Drug Combinations; Female; Fluorouracil; Gastrectomy; Humans; Laparoscopy; Laparotomy; Lymph Node Excision; Male; Middle Aged; Organoplatinum Compounds; Oxaliplatin; Oxaloacetates; Oxonic Acid; Pancreatic Fistula; Postoperative Complications; Retrospective Studies; Stomach Neoplasms; Tegafur; Time Factors; Time-to-Treatment

Pancreatic fistula (PF) is one of the leading complications after pancreatic resection for pancreatic carcinoma. The aim of this study was to determine whether PF was associated with deterioration of long-term outcomes in patients with pancreatic carcinoma after surgical resection.. Medical records of 210 patients with pancreatic carcinoma who underwent tumor resection were reviewed retrospectively. PF was defined as grade B or C PF according to the criteria of the International Study Group on Pancreatic Fistula. Clinicopathological factors including overall survival were compared between patients with and without PF by univariate and multivariate analyses.. Thirty-one patients (15 %) developed postoperative PF, and 179 (85 %) did not. The 31 cases of PF consisted of 27 grade B PF and 4 grade C PF. There were no differences in the use of adjuvant chemotherapy, tumor differentiation, lymph node status, surgical margin status, or UICC stage between groups. Overall 5-year survival rates for patients with and without PF were 25 and 27 %, respectively. There was no significant difference in overall survival between the two groups (P = 0.743). Multivariate analysis demonstrated that the use of postoperative adjuvant chemotherapy (P < 0.001), tumor differentiation (P = 0.005), and lymph node metastasis (p < 0.001) were factors independently associated with overall survival.. These results suggested that PF was not associated with deterioration of long-term outcomes in patients with pancreatic carcinoma. However, further analyses on larger number of patients are needed to determine a negative effect of grade C PF on long-term survival.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Carcinoma; Chemotherapy, Adjuvant; Deoxycytidine; Drug Combinations; Female; Gemcitabine; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Grading; Oxonic Acid; Pancreatectomy; Pancreatic Fistula; Pancreatic Neoplasms; Severity of Illness Index; Survival Rate; Tegafur