Téoule Patrick, Trojan Jörg, Bechstein Wolf, Woeste Guido
Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.
Dig Surg. 2015;32(4):229-37. doi: 10.1159/000381884. Epub 2015 May 7.
BACKGROUND/AIMS: Patients with locally advanced gastric cancer benefit from neoadjuvant chemotherapy. Potential disadvantages of neoadjuvant chemotherapy include increased surgical complications, leading to increased postoperative morbidity.
We retrospectively studied medical records of 135 patients with resectable cancer of the stomach who underwent gastrectomy between 2002 and 2009. The impact of neoadjuvant chemotherapy on postoperative morbidity was investigated. We compared demographic, clinical and operative data, morbidity and mortality from 105 patients who received surgical treatment immediately after diagnosis (SURG group), versus 30 patients who first received neoadjuvant chemotherapy (CHEMO group).
Demographic, clinical and surgical procedure parameters did not differ significantly between both groups. Postoperative morbidity was 46.7% in CHEMO- and 41.9% in SURG-patients (p = 0.680). There were eight cases of death, 2/30 (6.7%) in CHEMO and 6/105 (5.7%) in the SURG group (p = 1). The overall complications according to Clavien-classification did not differ significantly (p = 0.455). The wound infection rate (23.3 vs. 3.8%; p = 0.002) and insufficiency of the duodenal stump (13.3 vs. 1.9%; p = 0.022) were significantly higher in the CHEMO group.
This study showed no significant impact of neoadjuvant chemotherapy on postoperative morbidity after gastrectomy using the Clavien-classification. Only an increase in wound infections in CHEMO compared with the SURG group were noted. Therefore, neoadjuvant chemotherapy can be considered safe and feasible.
背景/目的：局部晚期胃癌患者可从新辅助化疗中获益。新辅助化疗的潜在缺点包括手术并发症增加，导致术后发病率上升。
我们回顾性研究了2002年至2009年间接受胃切除术的135例可切除胃癌患者的病历。研究了新辅助化疗对术后发病率的影响。我们比较了105例诊断后立即接受手术治疗的患者（手术组）与30例首先接受新辅助化疗的患者（化疗组）的人口统计学、临床和手术数据、发病率和死亡率。
两组的人口统计学、临床和手术程序参数无显著差异。化疗组患者的术后发病率为46.7%，手术组患者为41.9%（p = 0.680）。有8例死亡，化疗组2/30（6.7%），手术组6/105（5.7%）（p = 1）。根据Clavien分类法的总体并发症无显著差异（p = 0.455）。化疗组的伤口感染率（23.3%对3.8%；p = 0.002）和十二指肠残端漏发生率（13.3%对1.9%；p = 0.022）显著更高。
本研究表明，使用Clavien分类法，新辅助化疗对胃切除术后的发病率无显著影响。仅注意到化疗组与手术组相比伤口感染有所增加。因此，新辅助化疗可被认为是安全可行的。
