Impact of neoadjuvant therapy followed by laparoscopic radical gastrectomy with D2 lymph node dissection in Western population: A multi-institutional propensity score-matched study.
Aged
Antineoplastic Combined Chemotherapy Protocols
/ therapeutic use
Combined Modality Therapy
Female
Follow-Up Studies
Gastrectomy
/ mortality
Humans
Laparoscopy
/ mortality
Length of Stay
Male
Middle Aged
Neoadjuvant Therapy
/ mortality
Postoperative Period
Prognosis
Retrospective Studies
Stomach Neoplasms
/ pathology
Survival Rate
gastric cancer
laparoscopic gastrectomy
neoadjuvant therapy
oncological outcomes
postoparative complications
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
revised:
20
07
2021
received:
19
05
2021
accepted:
14
08
2021
pubmed:
26
8
2021
medline:
24
11
2021
entrez:
25
8
2021
Statut:
ppublish
Résumé
In the setting of a minimally invasive approach, we aimed to compare short and long-term postoperative outcomes of patients treated with neoadjuvant therapy (NAT) + surgery or upfront surgery in Western population. All consecutive patients from six Italian and one Serbian center with locally advanced gastric cancer who had undergone laparoscopic gastrectomy with D2 lymph node dissection were selected between 2005 and 2019. After propensity score-matching, postoperative morbidity and oncologic outcomes were investigated. After matching, 97 patients were allocated in each cohort with a mean age of 69.4 and 70.5 years. The two groups showed no difference in operative details except for a higher conversion rate in the NAT group (p = 0.038). The overall postoperative complications rate significantly differed between NAT + surgery (38.1%) and US (21.6%) group (p = 0.019). NAT was found to be related to a higher risk of postoperative morbidity in patients older than 60 years old (p = 0.013) but not in patients younger (p = 0.620). Conversely, no difference in overall survival (p = 0.41) and disease-free-survival (p = 0.34) was found between groups. NAT appears to be related to a higher postoperative complication rate and equivalent oncological outcomes when compared with surgery alone. However, poor short-term outcomes are more evident in patients over 60 years old receiving NAT.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
In the setting of a minimally invasive approach, we aimed to compare short and long-term postoperative outcomes of patients treated with neoadjuvant therapy (NAT) + surgery or upfront surgery in Western population.
METHODS
METHODS
All consecutive patients from six Italian and one Serbian center with locally advanced gastric cancer who had undergone laparoscopic gastrectomy with D2 lymph node dissection were selected between 2005 and 2019. After propensity score-matching, postoperative morbidity and oncologic outcomes were investigated.
RESULTS
RESULTS
After matching, 97 patients were allocated in each cohort with a mean age of 69.4 and 70.5 years. The two groups showed no difference in operative details except for a higher conversion rate in the NAT group (p = 0.038). The overall postoperative complications rate significantly differed between NAT + surgery (38.1%) and US (21.6%) group (p = 0.019). NAT was found to be related to a higher risk of postoperative morbidity in patients older than 60 years old (p = 0.013) but not in patients younger (p = 0.620). Conversely, no difference in overall survival (p = 0.41) and disease-free-survival (p = 0.34) was found between groups.
CONCLUSIONS
CONCLUSIONS
NAT appears to be related to a higher postoperative complication rate and equivalent oncological outcomes when compared with surgery alone. However, poor short-term outcomes are more evident in patients over 60 years old receiving NAT.
Identifiants
pubmed: 34432291
doi: 10.1002/jso.26657
pmc: PMC9291045
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1338-1346Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals LLC.
Références
Medicine (Baltimore). 2018 Oct;97(43):e12932
pubmed: 30412102
J Surg Oncol. 2019 Sep;120(4):676-684
pubmed: 31338834
Br J Surg. 1997 Nov;84(11):1567-71
pubmed: 9393281
J Clin Oncol. 2010 Dec 10;28(35):5210-8
pubmed: 21060024
Ann Surg Oncol. 2007 Jul;14(7):2010-7
pubmed: 17342569
Minim Invasive Ther Allied Technol. 2012 Sep;21(5):313-9
pubmed: 22793780
J Cancer. 2019 Jul 10;10(17):4106-4113
pubmed: 31417655
Updates Surg. 2014 Mar;66(1):1-6
pubmed: 24523031
Jpn J Clin Oncol. 2020 May 5;50(5):528-534
pubmed: 32134452
Int Stat Rev. 2010 Apr;78(1):40-64
pubmed: 21743766
J Gastrointest Surg. 2020 May;24(5):1000-1009
pubmed: 31152343
Indian J Surg Oncol. 2019 Jun;10(2):245-250
pubmed: 31168243
Cancers (Basel). 2020 Sep 29;12(10):
pubmed: 33003302
Surg Endosc. 2019 Jan;33(1):33-45
pubmed: 30386984
JAMA. 2019 May 28;321(20):1983-1992
pubmed: 31135850
Br J Surg. 2005 Sep;92(9):1099-102
pubmed: 15931657
J Gastrointest Surg. 2020 Jun;24(6):1278-1289
pubmed: 31140064
Ann Oncol. 2016 Sep;27(suppl 5):v38-v49
pubmed: 27664260
Br J Surg. 2005 Sep;92(9):1103-9
pubmed: 16106493
J Surg Oncol. 2021 Dec;124(8):1338-1346
pubmed: 34432291
J Surg Oncol. 2020 Apr;121(5):833-839
pubmed: 31943232
J Gastric Cancer. 2015 Sep;15(3):167-75
pubmed: 26468414
Ann Surg Oncol. 2021 Mar;28(3):1428-1436
pubmed: 32862371
Ann Oncol. 2013 Oct;24 Suppl 6:vi57-63
pubmed: 24078663
Ann Surg. 2019 Dec;270(6):983-991
pubmed: 30829698
J Clin Oncol. 2016 Apr 20;34(12):1350-7
pubmed: 26903580
Cancer Manag Res. 2019 Jul 03;11:6011-6018
pubmed: 31308742
Eur J Surg Oncol. 2015 Mar;41(3):333-8
pubmed: 25498359
Eur J Surg Oncol. 2018 May;44(5):613-619
pubmed: 29503129
World J Surg Oncol. 2011 Sep 26;9:110
pubmed: 21942969
J Clin Oncol. 2011 May 1;29(13):1715-21
pubmed: 21444866
Eur J Cancer. 2020 May;130:146-154
pubmed: 32208351
Ann Surg. 2011 Nov;254(5):684-93; discussion 693
pubmed: 22005144
J Hematol Oncol. 2015 May 15;8:52
pubmed: 25976888
Gastric Cancer. 2021 Jan;24(1):258-271
pubmed: 32737637
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
Surg Today. 2020 Jan;50(1):30-37
pubmed: 31612329
Ann Surg Oncol. 2015 Oct;22(11):3632-9
pubmed: 25676845
Gastric Cancer. 2017 Mar;20(2):368-378
pubmed: 26961133
Surg Endosc. 2022 Apr;36(4):2300-2311
pubmed: 33877411
J Surg Oncol. 2020 Aug;122(2):293-305
pubmed: 32350878
World J Gastroenterol. 2020 Feb 28;26(8):818-827
pubmed: 32148379
N Engl J Med. 2006 Jul 6;355(1):11-20
pubmed: 16822992
PLoS One. 2014 Jan 30;9(1):e86941
pubmed: 24497999
CA Cancer J Clin. 2018 Nov;68(6):394-424
pubmed: 30207593
Surg Endosc. 2020 Sep;34(9):3818-3826
pubmed: 31591656
Lancet. 2019 May 11;393(10184):1948-1957
pubmed: 30982686
Cancers (Basel). 2019 Jan 11;11(1):
pubmed: 30641964
J Clin Oncol. 2020 Oct 1;38(28):3304-3313
pubmed: 32816629