The effect of neoadjuvant radiation therapy on perioperative outcomes among patients undergoing resection of retroperitoneal sarcomas

Daniel P. Nussbaum, Paul J. Speicher, Brian C. Gulack, Asvin M. Ganapathi, Jeffrey E. Keenan, Sandra S. Stinnett, David G. Kirsch, Douglas Tyler, Dan G. Blazer

Research output: Contribution to journalReview article

13 Citations (Scopus)

Abstract

BACKGROUND: Neoadjuvant radiation therapy (RT) has several theoretical benefits in the treatment of retroperitoneal sarcoma (RPS), but concerns remain about treatment toxicity and perioperative morbidity. There are limited data regarding its effect on perioperative outcomes, most of which come from small, single-institution series. The purpose of this study was to evaluate the short-term (30-day) postoperative morbidity and mortality associated with neoadjuvant RT following resection of RPS.

METHODS: The 2005-2011 National Surgical Quality Improvement Program Participant User File was queried for patients undergoing RPS resection. Subjects were stratified by use of neoadjuvant RT. Perioperative variables and short-term 30-day outcomes were compared. Groups were then propensity matched using a 2:1 nearest-neighbor algorithm and multivariable logistic regression was performed to assess neoadjuvant RT as a predictor of short-term 30-day outcomes.

RESULTS: A total of 785 patients were identified. Neoadjuvant RT was administered to 71 (9.0%). Patients who received neoadjuvant RT were slightly younger (56 vs. 62 years, p < 0.001), but otherwise the groups were similar. After propensity matching, all baseline characteristics were highly similar. Median operative time was longer in the neoadjuvant RT group (279 vs. 219 min, p < 0.01), but there were no differences in mortality (1.4 vs. 2.1%, p = 0.71), major complications (28.2 vs. 25.2%, p = 0.69), overall complications (35.2 vs.33.2%, p = 0.83), early reoperation (5.6 vs. 7.4%, p = 0.81), or length of stay (7 vs. 7 days, p = 0.56). Following further adjustment with logistic regression, we confirmed that there were no differences in 30-day mortality or morbidity between patients who did and did not receive neoadjuvant RT.

CONCLUSIONS: Neoadjuvant RT does not appear to increase short-term (30-day) morbidity or mortality following resection of RPS. Continued investigation is needed to better define the role for radiation therapy among patients with this disease.

Original languageEnglish (US)
Pages (from-to)155-160
Number of pages6
JournalSurgical Oncology
Volume23
Issue number3
DOIs
StatePublished - Sep 1 2014
Externally publishedYes

Fingerprint

Neoadjuvant Therapy
Sarcoma
Radiotherapy
Morbidity
Mortality
Logistic Models
Operative Time
Quality Improvement
Reoperation
Length of Stay

Keywords

  • 30-day outcomes
  • Neoadjuvant
  • Outcomes
  • Preoperative
  • Radiation therapy
  • Radiotherapy
  • Retroperitoneal sarcoma
  • Sarcoma
  • Short-term outcomes

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Nussbaum, D. P., Speicher, P. J., Gulack, B. C., Ganapathi, A. M., Keenan, J. E., Stinnett, S. S., ... Blazer, D. G. (2014). The effect of neoadjuvant radiation therapy on perioperative outcomes among patients undergoing resection of retroperitoneal sarcomas. Surgical Oncology, 23(3), 155-160. https://doi.org/10.1016/j.suronc.2014.07.001

The effect of neoadjuvant radiation therapy on perioperative outcomes among patients undergoing resection of retroperitoneal sarcomas. / Nussbaum, Daniel P.; Speicher, Paul J.; Gulack, Brian C.; Ganapathi, Asvin M.; Keenan, Jeffrey E.; Stinnett, Sandra S.; Kirsch, David G.; Tyler, Douglas; Blazer, Dan G.

In: Surgical Oncology, Vol. 23, No. 3, 01.09.2014, p. 155-160.

Research output: Contribution to journalReview article

Nussbaum, DP, Speicher, PJ, Gulack, BC, Ganapathi, AM, Keenan, JE, Stinnett, SS, Kirsch, DG, Tyler, D & Blazer, DG 2014, 'The effect of neoadjuvant radiation therapy on perioperative outcomes among patients undergoing resection of retroperitoneal sarcomas', Surgical Oncology, vol. 23, no. 3, pp. 155-160. https://doi.org/10.1016/j.suronc.2014.07.001
Nussbaum, Daniel P. ; Speicher, Paul J. ; Gulack, Brian C. ; Ganapathi, Asvin M. ; Keenan, Jeffrey E. ; Stinnett, Sandra S. ; Kirsch, David G. ; Tyler, Douglas ; Blazer, Dan G. / The effect of neoadjuvant radiation therapy on perioperative outcomes among patients undergoing resection of retroperitoneal sarcomas. In: Surgical Oncology. 2014 ; Vol. 23, No. 3. pp. 155-160.
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abstract = "BACKGROUND: Neoadjuvant radiation therapy (RT) has several theoretical benefits in the treatment of retroperitoneal sarcoma (RPS), but concerns remain about treatment toxicity and perioperative morbidity. There are limited data regarding its effect on perioperative outcomes, most of which come from small, single-institution series. The purpose of this study was to evaluate the short-term (30-day) postoperative morbidity and mortality associated with neoadjuvant RT following resection of RPS.METHODS: The 2005-2011 National Surgical Quality Improvement Program Participant User File was queried for patients undergoing RPS resection. Subjects were stratified by use of neoadjuvant RT. Perioperative variables and short-term 30-day outcomes were compared. Groups were then propensity matched using a 2:1 nearest-neighbor algorithm and multivariable logistic regression was performed to assess neoadjuvant RT as a predictor of short-term 30-day outcomes.RESULTS: A total of 785 patients were identified. Neoadjuvant RT was administered to 71 (9.0{\%}). Patients who received neoadjuvant RT were slightly younger (56 vs. 62 years, p < 0.001), but otherwise the groups were similar. After propensity matching, all baseline characteristics were highly similar. Median operative time was longer in the neoadjuvant RT group (279 vs. 219 min, p < 0.01), but there were no differences in mortality (1.4 vs. 2.1{\%}, p = 0.71), major complications (28.2 vs. 25.2{\%}, p = 0.69), overall complications (35.2 vs.33.2{\%}, p = 0.83), early reoperation (5.6 vs. 7.4{\%}, p = 0.81), or length of stay (7 vs. 7 days, p = 0.56). Following further adjustment with logistic regression, we confirmed that there were no differences in 30-day mortality or morbidity between patients who did and did not receive neoadjuvant RT.CONCLUSIONS: Neoadjuvant RT does not appear to increase short-term (30-day) morbidity or mortality following resection of RPS. Continued investigation is needed to better define the role for radiation therapy among patients with this disease.",
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T1 - The effect of neoadjuvant radiation therapy on perioperative outcomes among patients undergoing resection of retroperitoneal sarcomas

AU - Nussbaum, Daniel P.

AU - Speicher, Paul J.

AU - Gulack, Brian C.

AU - Ganapathi, Asvin M.

AU - Keenan, Jeffrey E.

AU - Stinnett, Sandra S.

AU - Kirsch, David G.

AU - Tyler, Douglas

AU - Blazer, Dan G.

PY - 2014/9/1

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N2 - BACKGROUND: Neoadjuvant radiation therapy (RT) has several theoretical benefits in the treatment of retroperitoneal sarcoma (RPS), but concerns remain about treatment toxicity and perioperative morbidity. There are limited data regarding its effect on perioperative outcomes, most of which come from small, single-institution series. The purpose of this study was to evaluate the short-term (30-day) postoperative morbidity and mortality associated with neoadjuvant RT following resection of RPS.METHODS: The 2005-2011 National Surgical Quality Improvement Program Participant User File was queried for patients undergoing RPS resection. Subjects were stratified by use of neoadjuvant RT. Perioperative variables and short-term 30-day outcomes were compared. Groups were then propensity matched using a 2:1 nearest-neighbor algorithm and multivariable logistic regression was performed to assess neoadjuvant RT as a predictor of short-term 30-day outcomes.RESULTS: A total of 785 patients were identified. Neoadjuvant RT was administered to 71 (9.0%). Patients who received neoadjuvant RT were slightly younger (56 vs. 62 years, p < 0.001), but otherwise the groups were similar. After propensity matching, all baseline characteristics were highly similar. Median operative time was longer in the neoadjuvant RT group (279 vs. 219 min, p < 0.01), but there were no differences in mortality (1.4 vs. 2.1%, p = 0.71), major complications (28.2 vs. 25.2%, p = 0.69), overall complications (35.2 vs.33.2%, p = 0.83), early reoperation (5.6 vs. 7.4%, p = 0.81), or length of stay (7 vs. 7 days, p = 0.56). Following further adjustment with logistic regression, we confirmed that there were no differences in 30-day mortality or morbidity between patients who did and did not receive neoadjuvant RT.CONCLUSIONS: Neoadjuvant RT does not appear to increase short-term (30-day) morbidity or mortality following resection of RPS. Continued investigation is needed to better define the role for radiation therapy among patients with this disease.

AB - BACKGROUND: Neoadjuvant radiation therapy (RT) has several theoretical benefits in the treatment of retroperitoneal sarcoma (RPS), but concerns remain about treatment toxicity and perioperative morbidity. There are limited data regarding its effect on perioperative outcomes, most of which come from small, single-institution series. The purpose of this study was to evaluate the short-term (30-day) postoperative morbidity and mortality associated with neoadjuvant RT following resection of RPS.METHODS: The 2005-2011 National Surgical Quality Improvement Program Participant User File was queried for patients undergoing RPS resection. Subjects were stratified by use of neoadjuvant RT. Perioperative variables and short-term 30-day outcomes were compared. Groups were then propensity matched using a 2:1 nearest-neighbor algorithm and multivariable logistic regression was performed to assess neoadjuvant RT as a predictor of short-term 30-day outcomes.RESULTS: A total of 785 patients were identified. Neoadjuvant RT was administered to 71 (9.0%). Patients who received neoadjuvant RT were slightly younger (56 vs. 62 years, p < 0.001), but otherwise the groups were similar. After propensity matching, all baseline characteristics were highly similar. Median operative time was longer in the neoadjuvant RT group (279 vs. 219 min, p < 0.01), but there were no differences in mortality (1.4 vs. 2.1%, p = 0.71), major complications (28.2 vs. 25.2%, p = 0.69), overall complications (35.2 vs.33.2%, p = 0.83), early reoperation (5.6 vs. 7.4%, p = 0.81), or length of stay (7 vs. 7 days, p = 0.56). Following further adjustment with logistic regression, we confirmed that there were no differences in 30-day mortality or morbidity between patients who did and did not receive neoadjuvant RT.CONCLUSIONS: Neoadjuvant RT does not appear to increase short-term (30-day) morbidity or mortality following resection of RPS. Continued investigation is needed to better define the role for radiation therapy among patients with this disease.

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KW - Neoadjuvant

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KW - Preoperative

KW - Radiation therapy

KW - Radiotherapy

KW - Retroperitoneal sarcoma

KW - Sarcoma

KW - Short-term outcomes

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