Impact of Pre-treatment Waiting Intervals on Short-term Postoperative Outcomes in Neoadjuvant Chemotherapy Followed by Gastrectomy: A Population-based Study Using the Dutch Upper Gastrointestinal Cancer Audit (DUCA) Data

Introduction: The pre-treatment waiting interval of gastric cancer patients receiving neoadjuvant chemotherapy (nCT) followed by gastrectomy includes pre-nCT (diagnosis to nCT) and preoperative (diagnosis to surgery) waiting intervals. This study aimed to investigate the impact of these two distinct intervals on short-term postoperative outcomes.

Methods: Patients (cT1-4aN0-3M0) who underwent nCT plus gastrectomy were included using the Dutch national DUCA-database. Multivariate logistic regression was used to determine the impact of the two waiting intervals upon short-term postoperative outcomes: pre-nCT waiting intervals (≤5, 5-8 and 8-12 weeks) and preoperative waiting intervals (≤17, 17-22, and >22 weeks).

Results: Between 2010 and 2021, 1242 patients were included. Compared to the pre-nCT waiting interval ≤5 weeks, the longer intervals (5-8 and 8-12 weeks) were not associated with worse 30-day mortality (p-value = 0.707; p-value = 0.900), overall complications (p-value = 0.733; p-value = 0.453), pulmonary complications (p-value = 0.250; p-value = 0.238), gastrointestinal complications (p-value = 0.396; p-value = 0.992), re-interventions (p-value = 0.407; p-value = 0.072) and 30-day readmission (p-value = 0.992; p-value = 0.664). Compared to the preoperative waiting interval ≤17 weeks, the longer intervals (17-22 and > 22 weeks) were also not associated with worse 30-day mortality (p-value = 0.926; p-value = 0.732), overall complications (p-value = 0.286; p-value = 0.510), pulmonary complications (p-value = 0.912; p-value = 0.351), gastrointestinal complications (p-value = 0.765; p-value = 0.882), re-interventions (p-value = 0.617; p-value = 0.800) and 30-day readmission (p-value = 0.592; p-value = 0.782).

Conclusion: A longer pre-nCT or preoperative waiting interval is not associated with worse short-term postoperative outcomes in Western gastric cancer patients undergoing nCT plus gastrectomy.