Return to Intended Oncologic Treatment (RIOT) in Resected Gastric Cancer Patients

  • Marcus Fernando Kodama Pertille RamosEmail author
  • Tiago Biachi de Castria
  • Marina Alessandra Pereira
  • Andre Roncon Dias
  • Fernanda Fronzoni Antonacio
  • Bruno Zilberstein
  • Paulo Marcelo Gehm Hoff
  • Ulysses RibeiroJr
  • Ivan Cecconello
2019 SSAT Plenary Presentation



Postoperative chemotherapy (CMT) or chemoradiotherapy (CRT) is commonly recommended for gastric cancer (GC) patients in order to improve survival. However, some factors that prevent patients from return to intended oncologic treatment (RIOT) may increase the risk of recurrence and decrease the survival benefits achieved with curative resection. The aim of this study was to determine the frequency and factors associated with inability to RIOT and their impact on survival.


This retrospective study included stage II/III GC patients treated with potentially curative gastrectomy. Patients who could return to intended oncologic treatment (RIOT group) and those who could not (inability to RIOT group) were analyzed.


Of the 313 eligible GC patients, 89 (28.4%) and 85 (27.2%) patients receive CRT and CMT, respectively, representing a RIOT rate of 55.6%. The main reason was attributed to general poor performance status (30.2%), followed by surgical postoperative complications (POC) (20.1%). Older age, higher ASA, D1 lymphadenectomy, and major POC were related to inability to RIOT. Older age, neutrophil-lymphocyte ratio (NLR), and major POC were independent risk factors for inability to RIOT. Five-year DFS and OS were worse for the inability to RIOT group than for the RIOT group (p = 0.008 and p = 0.004, respectively). In multivariate analyses, absence of neoadjuvant therapy, total gastrectomy, pT3/T4, pN+, and inability to RIOT were associated with worse DFS. Type of gastrectomy, lymphadenectomy, pN status, Rx resection, and RIOT group were associated with OS.


Older age, high NLR, and major POC were risk factors for inability to RIOT. RIOT was an independent predictor of survival.


Gastric cancer Stomach neoplasms Chemotherapy postoperative complications Oncologic treatment 


Authors Contributions

Marcus F.K.P. Ramos, Tiago B. de Castria, Marina A. Pereira: study design, data retrieval, statistical analysis, draft of the manuscript.

Andre R. Dias, Fernanda F Antonacio: data retrieval, review of the manuscript.

Bruno Zilberstein, Paulo M.G. Hoff, Ulysses Ribeiro Jr, Ivan Cecconello: critical analysis, review of the manuscript.

Compliance with Ethical Standards

The study was approved by the hospital ethics committee (NP993/16) and registered online ( Informed consent of patients was waived because of the retrospective nature of the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11605_2019_4462_MOESM1_ESM.docx (16 kb)
Supplementary Table 1 Postoperative complications for RIOT and inability to RIOT groups according to Clavien-Dindo classification. (DOCX 16 kb)
11605_2019_4462_MOESM2_ESM.docx (14 kb)
Supplementary Table 2 Adjuvant treatment trials and RIOT. (DOCX 13 kb)
11605_2019_4462_MOESM3_ESM.docx (14 kb)
Supplementary Table 3 Perioperative treatment trials and RIOT. (DOCX 14 kb)


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Marcus Fernando Kodama Pertille Ramos
    • 1
    Email author
  • Tiago Biachi de Castria
    • 1
  • Marina Alessandra Pereira
    • 1
  • Andre Roncon Dias
    • 1
  • Fernanda Fronzoni Antonacio
    • 1
  • Bruno Zilberstein
    • 1
  • Paulo Marcelo Gehm Hoff
    • 1
  • Ulysses RibeiroJr
    • 1
  • Ivan Cecconello
    • 1
  1. 1.Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSão PauloBrazil

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