Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
World J Surg Oncol. 2013 Feb 2;11:31. doi: 10.1186/1477-7819-11-31.
Patients with locally advanced resectable gastric cancers are increasingly offered neoadjuvant chemotherapy (NACT) following the MAGIC and REAL-2 trials. However, information on the toxicity of NACT, its effects on perioperative surgical outcomes and tumor response is not widely reported in literature.
Analysis of a prospective database of gastric cancer patients undergoing radical D2 gastrectomy over 2 years was performed. Chemotherapy-related toxicity, perioperative outcomes and histopathological responses to NACT were analyzed. The data is presented and compared to a cohort of patients undergoing upfront surgery in the same time period.
In this study, 139 patients (42 female and 97 male patients, median age 53 years) with gastric adenocarcinoma received NACT. Chemotherapy-related toxicity was noted in 32% of patients. Of the 139 patients, 129 underwent gastrectomy with D2 lymphadenectomy, with 12% morbidity and no mortality. Major pathological response of primary tumor was noted in 22 patients (17%). Of these 22 patients, lymph node metastases were noted in 12 patients. The median blood loss and lymph node yield was not significantly different to the 62 patients who underwent upfront surgery. Patients who underwent upfront surgery were older (58 vs. 52 years, P <0.02), had a higher number of distal cancers (63% vs. 82%, P <0.015) and a longer hospital stay (11 vs. 9 days, P <0.001).
Perioperative outcomes of gastrectomy with D2 lymphadenectomy for locally advanced, resectable gastric cancer were not influenced by NACT. The number of lymph nodes harvested was unaltered by NACT but, more pertinently, metastases to lymph nodes were noted even in patients with a major pathological response of the primary tumor. D2 lymphadenectomy should be performed in all patients irrespective of the degree of response to NACT.
MAGIC 和 REAL-2 试验后，越来越多局部可切除的胃癌患者接受新辅助化疗（NACT）。然而，关于 NACT 的毒性、对围手术期外科结局和肿瘤反应的影响的信息在文献中并未广泛报道。
对 2 年内接受根治性 D2 胃切除术的胃癌患者的前瞻性数据库进行分析。分析化疗相关毒性、围手术期结局和 NACT 的组织病理学反应。本研究的数据与同期接受直接手术的患者队列进行了比较。
本研究中，139 例（42 例女性，97 例男性，中位年龄 53 岁）胃腺癌患者接受了 NACT。32%的患者出现了化疗相关毒性。139 例患者中，129 例行 D2 淋巴结清扫术胃切除术，发病率为 12%，无死亡。129 例患者中，12 例有主要肿瘤的病理性反应。在这 22 例患者中，12 例患者的淋巴结转移。中位出血量和淋巴结产量与 62 例直接手术患者无显著差异。直接手术组患者年龄较大（58 岁比 52 岁，P <0.02），远端癌更多（63%比 82%，P <0.015），住院时间更长（11 天比 9 天，P <0.001）。
D2 淋巴结清扫术治疗局部可切除、进展期胃癌的围手术期结局不受 NACT 影响。NACT 并未改变淋巴结的检出数量，但更重要的是，即使在原发肿瘤有主要病理性反应的患者中，也发现了淋巴结转移。无论 NACT 反应程度如何，D2 淋巴结清扫术都应在所有患者中进行。
