Introduction: Neoadjuvant chemotherapy and radiation therapy are often indicated in the treatment of intracranial tumors. This study identified intraoperative and postoperative complications associated with chemotherapy and/or radiation therapy prior to tumor resection.
Methods: The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database was used to identify patients who underwent intracranial tumor resection between 2006 and 2014 based on Current Procedural Terminology (CPT) codes. Intraoperative or postoperative complications associated with patients treated with chemotherapy or radiation therapy prior to surgery were identified using chi square and multivariate logistic regression.
Results: A total of 17,634 patients who underwent intracranial tumor resections were identified. 722 patients (4.28%) received chemotherapy within 30 days and/or radiation therapy within 90 days prior to surgery. Three surgical complications were found to be associated with neoadjuvant chemotherapy. Complications associated with neoadjuvant chemotherapy include organ space surgical site infection (Odds ratio: 3.91; 95% CI: [1.90,8.04]), a stroke resulting in neurological deficits (Odds ratio: 2.42; 95% CI: [1.13,5.19]) and anesthesia time > 3 hours (Odds ratio: 37.46; 95% CI: [24.05,58.36]). Comparatively, neoadjuvant radiation therapy was also associated with anesthesia time > 3 hours (Odds ratio: 20.14; 95% CI: [12.4,32.66]), but no other complications.
Conclusions: Neoadjuvant chemotherapy and radiation therapy were both associated with increased time under anesthesia, which may be associated with further morbidity. Additionally, chemotherapy was associated with stroke and organ space SSI. In the future, surgeons may decide to take steps to prevent such postoperative complications when operating on patients who have recently been treated with chemotherapy.
Patient Care: Identifying postoperative complications associated with neoadjuvant chemotherapy and radiation therapy can allow neurosurgeons to take steps to prevent such complications in high-risk patients and improve outcomes.
Learning Objectives: - Describe intraoperative and postoperative complications associated with neoadjuvant chemotherapy
- Describe intraoperative and postoperative complications associated with neoadjuvant radiation therapy
- Discuss future directions in light of these findings