Does Chemotherapy Before Surgery Increase Surgical Risks for Stomach Cancer?
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Vasigh M, Ter-Minassian M, Meador E ...Does neoadjuvant chemotherapy lead to a higher postoperative complication rate and poorer surgical outcomes in patients with locally advanced gastric cancer? Surgical Oncology Insight, 2026; 3
Key Takeaway
For people with locally advanced gastric (stomach) cancer, receiving chemotherapy before surgery—known as neoadjuvant chemotherapy (NAC)—did not increase the risk of complications after surgery. In fact, patients who received chemotherapy first were less likely to be readmitted to the hospital within 30 days than those who went straight to surgery.
Why This Study Matters
Many patients with locally advanced stomach cancer receive chemotherapy before surgery to shrink the tumor, improve the chances of removing all of the cancer, and treat microscopic cancer cells that may have already spread.
While this approach has been shown to improve long-term outcomes, some patients worry that chemotherapy before surgery could make recovery more difficult or increase the risk of complications.
Researchers from Johns Hopkins and Kaiser Permanente wanted to determine whether these concerns are supported by real-world evidence.
What the Researchers Did
The study reviewed 226 patients with non-metastatic gastric cancer treated between 2015 and 2021.
Researchers compared patients who:
Received neoadjuvant chemotherapy before surgery
Underwent upfront surgery without chemotherapy
They looked at several short-term outcomes after surgery, including:
Postoperative complications
Length of hospital stay
Hospital readmissions
Death within 30 days of surgery
What the Researchers Found
The results were reassuring.
Researchers found that chemotherapy before surgery did not increase:
Overall surgical complications
Serious complications such as infections or anastomotic leaks
Length of hospital stay
The risk of dying within 30 days after surgery
One surprising finding was that patients who received chemotherapy before surgery were significantly less likely to be readmitted to the hospital within 30 days than patients who had surgery first (8% versus 20%).
Importantly, the patients who received chemotherapy generally had more advanced cancers and often required larger, more complex operations, yet their recovery was similar to those who underwent upfront surgery.
What This Means for Patients
If your care team recommends chemotherapy before surgery, these findings may provide reassurance.
Although it can feel concerning to delay surgery while receiving chemotherapy, this study suggests that doing so does not make surgery more dangerous for most patients with locally advanced stomach cancer.
Instead, neoadjuvant chemotherapy remains an important part of treatment because it can:
Shrink the tumor before surgery
Increase the likelihood of completely removing the cancer
Treat cancer cells that may have spread but cannot yet be detected
Help improve long-term outcomes without increasing short-term surgical risks
The Bottom Line
For patients with locally advanced gastric cancer, chemotherapy before surgery appears to be both safe and effective. This study found no increase in postoperative complications, hospital stay, or early mortality, while patients who received neoadjuvant chemotherapy actually experienced fewer hospital readmissions after surgery.
If chemotherapy before surgery is recommended as part of your treatment plan, these findings support that it can be delivered safely while preserving the benefits of surgery.
