Impact of Neoadjuvant Therapy on Minimally Invasive Surgical Outcomes in Advanced Gastric Cancer: An International Prope
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ORIGINAL ARTICLE – GASTROINTESTINAL ONCOLOGY
Impact of Neoadjuvant Therapy on Minimally Invasive Surgical Outcomes in Advanced Gastric Cancer: An International Propensity Score-Matched Study Yongjia Yan, MD PhD1,2, Annie Yang, MD1, Li Lu, MD2, Zhicheng Zhao, MD2, Chuan Li, MD2, Weidong Li, MD2, Joseph Chao, MD3, Tong Liu, MD2, Yuman Fong, MD1, Weihua Fu, MD, PhD2, and Yanghee Woo, MD1,4 1
Division of Surgical Oncology, Department of Surgery, City of Hope National Comprehensive Cancer Center, Duarte, CA; 2Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China; 3Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA; 4Cancer Immunotherapeutics Program, Beckman Research Institute, City of Hope, Duarte, CA
ABSTRACT Background. 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. Methods. 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. Riskfactor of complications was analyzed in the whole cohort. Results. 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.
Ó Society of Surgical Oncology 2020 First Received: 12 June 2020 Accepted: 8 August 2020 W. Fu, MD, PhD e-mail: [email protected] Y. Woo, MD e-mail: [email protected]
6.9 ± 2.1 9 109/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 C 60 years (OR, 21.338; 95% CI, 5.00–91.05; P \ 0.001), tumor size C 5 cm (OR, 1.24; 95% CI, 1.08–1.83; P \ 0.001), operation time C 240 min (OR, 5.53; 95% CI, 1.26–24.26; P = 0.012), and ASA classification C II (OR, 13.14; 95% CI, 4.12–24.73; P \ 0.001). Conclusions. 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.
Gastric adenocarcinoma (GC) is a global healthcare challenge that is defined by significant geographic heterogeneity in incidence, treatment strategies, and outcomes. Less invasive surgical techniques and more effective systemic treatments co
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