Impact of neoadjuvant chemoradiotherapy (NACRT) vs neoadjuvant chemotherapy (NACT) on anastomotic complications in gastric carcinoma.

Background: Our institution conducted a pilot study of neoadjuvant chemoradiotherapy (NACRT) in carcinoma stomach. The surgical complications were compared with a contemporary cohort of patients receiving neoadjuvant chemotherapy (NACT) in carcinoma stomach. Materials and Methods: Patients who underwent neoadjuvant therapy followed by curative gastrectomy between 2015-2022 were included in this ambispective analysis. These patients were divided into groups: Group 1: NACT and Group 2: NACRT. NACT was given as 3 cycles of ECX/ECF, while NACRT was given as 2 cycles of CX chemotherapy (CT) followed by concurrent radiotherapy (RT) to a dose of 45 Gy/25 # with Intensity-modulated radiation therapy (IMRT) technique and concurrent Capecitabine(X). The primary outcome measure was anastomotic complications, which were compared between groups. Crude percentages, median, and means are reported and compared using the chi-square test and t-test. Univariable and multivariable analyses were performed to identify predictors of complications. Results: During this period, 42 patients who underwent curative resections were identified. The median age was 51 years (IQR 42-65). The majority (50%) had an antropyloric location, 32 (76%) patients had T3/4 disease, and 27 (64%) patients had node-positive disease. Of them, 27 (64%) patients received NACT, and the remaining 15 (36%) received NACRT. Most had distal/subtotal gastrectomy (48%) and Billroth II reconstruction (36%). At a median follow-up of 28 months, overall anastomotic complications were seen in 6 (14%) patients, anastomotic leak in 4 (9%) and anastomotic stenosis in 6 (14%) patients. The incidence of anastomotic leak was 7% vs 13% (p=0.53), and anastomotic stenosis was 7% vs 27% (p=0.08) in Grp 1 vs 2. Overall, anastomotic complications were 7% vs 27% (p=0.08), pulmonary (29.6 %vs 26.7%, p=0.839) and cardiac complications (0 vs 6.7%, p=0.174) in groups 1 vs 2. The median duration of hospital stay was 12 vs. 14 days (p=0.84), and the 90-day mortality rate was 3.7% vs 0%, p=0.45 in groups 1 vs 2. On multivariable regression analysis, increasing age (p=0.04, OR=0.91), NACRT (p=0.04, OR=14.6), and adjuvant therapy (p=0.03, OR=24.7) were predictors of overall anastomotic complications. Conclusion: NACRT increases anastomotic complications as compared to NACT and should be used cautiously in patients with GC.