Survival prognostic impact of post-surgical complications in gastric cancer patients after neoadjuvant chemotherapy: a single western center analysis

It's well known that postoperative complications (POC) negatively invalidate survival of patients who underwent surgery for gastric cancer (GC). Our study evaluates POC clinical impact in the prognosis of patients underwent neoadjuvant chemotherapy (NAC) for locally advanced Gastric Cancer (LAGC). We enrolled 256 patients who underwent D2/D3 gastric resection in a curative way for LAGC. 50 patients underwent NAC according to FLOT scheme. Overall survival (OS) and Disease free survival (DFS) were investigated by univariate and multivariate analysis in NAC and non NAC patients. There were 115 and 27 POC occurrences respectively in upfront surgery group and NAC one. 5 year-OS in upfront surgery patients was better in the arm without POC (59.1% vs. 52.1%), whereas 5 year-OS in NAC cohort was 81% and 79.7% for respectively patients with or without POC (p = 0.81, HR 1.196). 5y-OS strongly improved in patients with POC who underwent NAC rather than patients who underwent upfront surgery (81% vs 52.1%, respectively; p = 0.04, HR 2.186). NAC remains the gold standard treatment for patients with locally advanced GC and it could be a positive prognostic factor for patients with POC. We demonstrated that the negative POC impact was reduced by positive NAC effect. Prospective and larger studies need to build exact evidence.