Feng Qing, Long Du, Du Ming-Shan, Wang Xiao-Song, Li Zhen-Shun, Zhao Yong-Liang, Qian Feng, Wen Yan, Yu Pei-Wu, Shi Yan
Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China.
Radiology Department, The First Affiliated Hospital, Army Medical University, Chongqing, China.
Front Oncol. 2021 Sep 29;11:690662. doi: 10.3389/fonc.2021.690662. eCollection 2021.
Laparoscopic gastrectomy (LG) has been increasingly used for the treatment of locally advanced Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG). However, whether LG can achieve the same short-term efficacy in the treatment of patients who receive neoadjuvant chemotherapy (NACT) remains controversial. Thus, the aim of this study was to investigate the clinical outcomes of NACT combined with LG for Siewert type II and III AEG.
This retrospective study identified patients with locally advanced Siewert type II and III AEG diagnosed between May 2011 and October 2020 using the clinical tumor-node-metastasis (cTNM) staging system. The short-term outcomes were compared between the matched groups using a 1:3 propensity score matching (PSM) method, which was performed to reduce bias in patient selection.
After PSM, 164 patients were selected, including 41 in the NACT group and 123 in the LG group. The baseline characteristics were similar between the two groups. Compared with the LG group, the NACT group exhibit a smaller tumor size and significantly less advanced pathological tumor classification and nodal classification stages. The time to first flatus of the NACT group was significantly shorter, but the hospital stay was significantly longer than that of the LG group. The NACT group showed similar overall (29.3% 25.2%, P=0.683), systemic (24.4% 21.1%, P=0.663), local (12.2% 9.8%, P=0.767), minor (19.5% 19.5%, P=1.000) and major (9.8% 5.7%, P=0.470) complications as the LG group. Subgroup analyses showed no significant differences in most stratified parameters. Operation time≥ 300 minutes was identified as an independent risk factor for overall complications. Age≥ 60 years was identified as an independent risk factor for major complications.
NACT combined with LG for AEG does not increase the risk of postoperative morbidity and mortality compared with LG.
腹腔镜胃切除术（LG）已越来越多地用于治疗局部进展期食管胃交界部（AEG）的Siewert II型和III型腺癌。然而，LG在治疗接受新辅助化疗（NACT）的患者时是否能取得相同的短期疗效仍存在争议。因此，本研究的目的是探讨NACT联合LG治疗Siewert II型和III型AEG的临床疗效。
本回顾性研究纳入了2011年5月至2020年10月期间使用临床肿瘤-淋巴结-转移（cTNM）分期系统诊断为局部进展期Siewert II型和III型AEG的患者。使用1:3倾向评分匹配（PSM）方法比较匹配组之间的短期结局，该方法用于减少患者选择中的偏差。
PSM后，共纳入164例患者，其中NACT组41例，LG组123例。两组的基线特征相似。与LG组相比，NACT组肿瘤体积较小，病理肿瘤分级和淋巴结分级分期明显较低。NACT组首次排气时间明显缩短，但住院时间明显长于LG组。NACT组的总体（29.3%对25.2%，P = 0.683）、全身（24.4%对21.1%，P = 0.663）、局部（12.2%对9.8%，P = 0.767）、轻微（19.5%对19.5%，P = 1.000）和严重（9.8%对5.7%，P = 0.470）并发症与LG组相似。亚组分析显示，大多数分层参数无显著差异。手术时间≥300分钟被确定为总体并发症的独立危险因素。年龄≥60岁被确定为严重并发症的独立危险因素。
与LG相比，NACT联合LG治疗AEG不会增加术后发病和死亡风险。
