Neoadjuvant chemotherapy followed by laparoscopic D2 gastrectomy in the treatment of advanced T3-4 resectable gastric cancer

Lukashenko A., Boiko A.V.

Summary. Introduction. The prognosis for patients with advanced gastric cancer remains poor, highlighting the need to improve treatment strategies. We analyzed data of patients with resectable advanced gastric cancer who received neoadjuvant chemotherapy (NAC) followed by laparoscopic distal subtotal gastrectomy (LDSG) or gastrectomy (LG) with D2 lymphadenectomy to assess the efficacy and safety of the combination of these treatments. Methods. In the study were included patients with advanced gastric adenocarcinoma (cT3–4 and/or N + M0) who received neoadjuvant chemotherapy XELOX (three preoperative and three postoperative 2-week cycles) at the National Cancer Institute from 2016–2018. The stage of disease was clarified by laparoscopic diagnostic laparoscopy before starting treatment. LDSG or LG was performed 3–4 weeks after completion of the last cycle of preoperative chemotherapy. The volume of surgical intervention was determined according to the location and type of tumor growth. Results. The study analyzed data from 46 patients. 40 patients (86.9%) received three courses of XELOX, while 6 patients (13,1%) received two courses of treatment. The degree of tumor response to chemotherapy was assessed in accordance with the RECIST criteria. Complete response after NAC was observed in 7 (15,2%) patients, partial response — in 29 (63,0%), stable disease — in 6 (13,0%), in 4 patients (8,2%) — progression during treatment. The spectrum of NAC adverse reactions grade 3/4 included: leukopenia (21,7%), neutropenia (32,6%), anemia (17,4%), weight loss (19,6%) and nausea (21,7%). The assessment of the oncological effect of further surgical intervention included the R0 level of resection, which was 97,8%, and the average number of delivered regional lymph nodes was 18,5. Morphological complete regression was 13,0%. Postoperative complications were noted in 7 (15,2%) patients, grade III (according to the Clavien-Dindo classification) were observed in 2 patients. All complications were successfully treated conservatively without the need for reoperation. There were no cases of treatment-related mortality. Long-term results were: 3-year overall survival rate is 30,1%, disease-free survival rate — 28,5%. Conclusions. The results of this study showed the efficacy and safety of NAC followed by LDSG or LG with D2 lymphadenectomy in advanced gastric cancer. Postoperative complications rate was relatively low in the combination of NAC with LDSG or LG, and did not require additional surgical procedures.

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