Trends in the use and impact of neoadjuvant chemotherapy on perioperative outcomes for resected @entity356 : Evidence from the American College of Surgeons National XXXX Database.

@entity1 @entity137 @entity5 @entity4207 @entity356
BACKGROUND: Standard of care for @entity1 with advanced @entity356 includes administration of neoadjuvant chemotherapy (NAC) before resection. This study assesses the pattern of use and impact of NAC on perioperative outcomes in US medical centers. METHODS: Using the American College of Surgeons National @entity5 Database, 16,128 @entity1 underwent gastrectomy for @entity5 from 2003 to 2012. Treatment groups were categorized as NAC or no NAC (ie, adjuvant chemotherapy and surgery only). Univariate and multivariate analyses were performed to estimate trends in utilization and impact of treatment on perioperative outcomes. RESULTS: Of @entity1 undergoing gastrectomy, 36.6% received NAC and 63.4% did not receive chemotherapy in the neoadjuvant setting. @entity1 who received NAC were more frequently younger, male, white, privately insured, with fewer comorbidities, and treated at an @entity4207 center (all P  <  .0001). After  controlling for demographics, comorbidities, and @entity5 -related factors, @entity1 who received NAC had a postoperative duration of stay 0.43  days shorter than @entity1 who did not receive chemotherapy (5.79 vs 6.22  days; P  =  .050). They had a 36% lower odds of 30-day mortality (odds ratio, 0.64, P  <  .0001) but nonsignificant lower odds of 90-day mortality. Use of NAC increased annually, with the greatest increases seen in @entity4207 facilities and in the Northeast and North Central United States. CONCLUSION: With concerns regarding the @entity137 of NAC, these findings suggest that NAC is not associated with worse postoperative outcomes. In light of evidence touting the benefits of NAC, its adoption as a component in the multimodality care of @entity356 is slowly increasing, although use of NAC remains poor overall.
