Concurrent neoadjuvant chemotherapy is an independent risk factor of stroke, all-cause morbidity, and mortality in patients undergoing brain tumor resection

Neoadjuvant chemotherapy (NC) may be utilized for treatment of various tumors, and a proportion of patients on active NC may require resection of a primary or secondary brain tumor. The objective of this study is to examine the impact of NC on postoperative neurosurgical outcomes. Elective cranial neurosurgical patient data was obtained from the American College of Surgeons National Surgical Quality Improvement Program database between 2006 and 2012. The impact of NC on 30 day stroke, all-cause postoperative morbidity, and mortality were assessed. Adjusted odds ratios (OR) were estimated for stroke, overall morbidity, and mortality using a multivariable logistic regression model, accomplished in stepwise fashion, for patients receiving NC versus those not receiving NC. This study analyzed 3812 patients undergoing elective cranial surgery, with 152 on concurrent NC. NC patients had a complication rate of 23.68%, while patients not receiving NC had a lower complication rate at 17.65% (p = 0.057). Multivariable regression analysis revealed that patients who received NC had significantly increased odds of developing a stroke with neurological deficit (OR 3.39; 95% confidence interval [CI] 1.37-8.40) and all-cause postoperative morbidity (OR 1.57; 95% CI 1.04-2.37) over the control group. Finally, the NC cohort demonstrated higher odds of mortality following surgery than their non-NC counterparts (OR 3.81; 95% CI 1.81-8.02). Ninety-two patients (2.41%) died within 30 days, of whom 10 (6.58%) were receiving NC versus 82 non-NC (2.24%) patients (p = 0.001). Concurrent NC is associated with an increased risk of short-term stroke with neurological deficit, all-cause morbidity, and mortality in patients undergoing brain tumor resection.