Division of Surgical Oncology, Department of Surgery, City of Hope National Comprehensive Cancer Center, Duarte, CA, USA.
Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China.
Ann Surg Oncol. 2021 Mar;28(3):1428-1436. doi: 10.1245/s10434-020-09070-9. Epub 2020 Aug 29.
No international consensus on the treatment of advanced gastric cancer (AGC) exists. In the absence of well-designed, comparative studies between neoadjuvant versus adjuvant strategies, concerns about increased risk of postoperative complications remain barriers to neoadjuvant chemotherapy (NAC) for AGC. We evaluated surgical outcomes of AGC patients who received minimally invasive radical gastrectomy with D2 lymphadenectomy after NAC.
We collected data from two high-volume gastric cancer programs in the United States and China between January 2015 and December 2019 with the last follow-up in February 2020. AGC patients undergoing minimally invasive radical surgery were included. After propensity score-matching, surgical outcomes were analyzed. Risk-factor of complications was analyzed in the whole cohort.
After 1:1 propensity score-matching, 97 patients were included in each cohort. NAC + surgery cohort was younger (58.2 ± 10.3 vs. 61.3 ± 9.6, P = 0.036) with lower preoperative WBC count (5.7 ± 2.8 vs. 6.9 ± 2.1 × 10/ml) than the surgery upfront cohort. NAC was not a risk-factor for postoperative complications (odds ratio [OR], 0.859; 95% confidence interval [CI], 0.46-1.60; P = 0.633). Overall risk-factors of postoperative complications included age ≥ 60 years (OR, 21.338; 95% CI, 5.00-91.05; P < 0.001), tumor size ≥ 5 cm (OR, 1.24; 95% CI, 1.08-1.83; P < 0.001), operation time ≥ 240 min (OR, 5.53; 95% CI, 1.26-24.26; P = 0.012), and ASA classification ≥ II (OR, 13.14; 95% CI, 4.12-24.73; P < 0.001).
NAC before minimally invasive radical gastrectomy with D2 lymphadenectomy does not increase postoperative complications, and these findings support broader application of NAC and MIS for AGC. Additional studies are required to determine the effect of NAC on long-term survival.
目前对于晚期胃癌（AGC）的治疗尚未达成国际共识。由于新辅助治疗与辅助治疗策略之间缺乏精心设计的比较研究，人们对术后并发症风险增加的担忧仍然是阻碍 AGC 患者接受新辅助化疗（NAC）的因素。本研究评估了接受 NAC 后行微创根治性胃切除术并进行 D2 淋巴结清扫术的 AGC 患者的手术结局。
我们在美国和中国的两个高容量胃癌项目中收集了 2015 年 1 月至 2019 年 12 月期间的数据，最后随访时间为 2020 年 2 月。纳入接受微创根治性手术的 AGC 患者。通过倾向评分匹配后，分析手术结果。在整个队列中分析并发症的危险因素。
经过 1:1 倾向评分匹配后，每组纳入 97 例患者。NAC+手术组的患者更年轻（58.2±10.3 岁比 61.3±9.6 岁，P=0.036），术前白细胞计数（5.7±2.8 比 6.9±2.1×10/ml）更低。NAC 不是术后并发症的危险因素（比值比 [OR]，0.859；95%置信区间 [CI]，0.46-1.60；P=0.633）。术后并发症的总体危险因素包括年龄≥60 岁（OR，21.338；95%CI，5.00-91.05；P<0.001）、肿瘤大小≥5cm（OR，1.24；95%CI，1.08-1.83；P<0.001）、手术时间≥240 分钟（OR，5.53；95%CI，1.26-24.26；P=0.012）和 ASA 分级≥II 级（OR，13.14；95%CI，4.12-24.73；P<0.001）。
AGC 患者接受微创根治性胃切除术并进行 D2 淋巴结清扫术前行 NAC 不会增加术后并发症，这些发现支持更广泛地应用 NAC 和微创手术治疗 AGC。需要进一步研究来确定 NAC 对长期生存的影响。
