Operative Results and Perioperative Morbidity After Intensified Neoadjuvant Chemotherapy with FLOT for Gastroesophageal Adenocarcinoma Impact of Intensified Neoadjuvant Treatment

Abstract

Background

Perioperative treatment is the standard of care in Western Europe for locally advanced gastric cancer (GC) and adenocarcinoma of the gastroesophageal junction (GEJ). Intensified neoadjuvant treatment within the NeoFLOT trial proved to be safe and effective. Yet, the influence of such intensification with 6 cycles of FLOT in the neoadjuvant setting has not been analyzed regarding its possible impact on perioperative results.

Materials and Methods

A total of 537 patients were enrolled in this study; of whom, 132 had followed a standard neoadjuvant protocol (CTx), 356 had not received any neoadjuvant treatment (NoCTx), and 49 patients had undergone an intensified chemotherapy within the NeoFLOT trial (IntCTx) with 6 cycles of FLOT (5-FU, leucovorin, oxaliplatin, docetaxel) every 2 weeks.

Results

Our results reveal no significant difference in perioperative morbidity or mortality with regard to the neoadjuvant treatment. Postoperative bleeding and hematoma occurred less frequently in the IntCTx group compared to the NoCTx and the CTx groups (2.0% vs. 5.33% vs. 5.1%). Postoperative lymph fistulas were slightly more frequent in the IntCTx group (4.1% vs. 0.3% vs. 1.6%). Patients treated within the NeoFLOT trial had a higher risk for blood transfusions (OR 5.5; 95%-KI, 2.49–12.19), whereas patients without neoadjuvant therapy had the longest ICU stay (mean 8.3 vs. CTx 4.5 vs. IntCTx 6.7 days).

Conclusion

The results of the current study indicate that also an intensification of neoadjuvant chemotherapy with 6 preoperative cycles of FLOT does not significantly increase perioperative complications. Thus, prolonged neoadjuvant chemotherapy with FLOT is safe for patients with locally advanced GC or GEJ tumors.

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Acknowledgments

We like to thank Dr. A. Crispin for statistical counseling and support.

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Authors

Contributions

Petra Ganschow: conceptual development of study, review of data, statistical analysis, analysis and interpretation of results, primary author of manuscript, critical review of possible impact on clinical management, final approval of manuscript

Lena Hofmann: acquisition of data, statistical analysis of data, interpretation of results and possible impact on clinical management, review of manuscript, final approval of manuscript

Sebastian Stintzing: review of study concept, analysis and interpretation of results, critical review of manuscript and impact on clinical management, final approval of manuscript

Volker Heinemann: critical review of study concept, analysis and interpretation of results, critical review of manuscript, final approval of manuscript

Martin Angele: conceptual development of study, review of data, analysis and interpretation of results, revision of manuscript, final approval of manuscript

Jens Werner: critical review of study concept, review and interpretation of results, critical review of manuscript, revision of manuscript, final approval of manuscript

Christoph Schulz: conceptual development of study, review of data, statistical analysis, analysis and interpretation of results, critical review of possible impact on clinical management, review of manuscript, final approval of manuscript

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Correspondence to Petra Ganschow.

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Ganschow, P., Hofmann, L., Stintzing, S. et al. Operative Results and Perioperative Morbidity After Intensified Neoadjuvant Chemotherapy with FLOT for Gastroesophageal Adenocarcinoma Impact of Intensified Neoadjuvant Treatment. J Gastrointest Surg 25, 58–66 (2021). https://doi.org/10.1007/s11605-019-04511-7

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Keywords

  • Gastroesophageal adenocarcinoma
  • Gastric cancer
  • Neoadjuvant chemotherapy
  • Intensified chemotherapy
  • Perioperative results