The Effect of Neoadjuvant Chemotherapy Combined with Laparoscopic Surgery on the Prognosis of Advanced Gastric Cancer

Abstract
Figure/Table
References
Related Citation (15)

Download: PDF (7312 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective: To investigate the effect of neoadjuvant chemotherapy combined with laparoscopic surgery on the prognosis of advanced gastric cancer. Methods: From January 2014 to January 2016, 96 patients with advanced gastric cancer were selected from the general surgery department of the Fourth People's Hospital of Haikou. All patients underwent laparoscopic radical gastrectomy. According to the wishes of patients and their families, patients were divided into study group and control group, 48 cases in each group. The control group received laparoscopic gastrectomy, and the study group received laparoscopic gastrectomy after neoadjuvant chemotherapy. To analyze the curative effect and adverse reactions of the patients in the study group after chemotherapy; to compare the perioperative indexes and the incidence of postoperative complications of the two groups, and to compare the R0 resection rate of the two groups. The patients were followed up to find out the postoperative survival, and the 1-year, 2-year and 3-year survival rates of the two groups were compared. Results: All patients in the study group completed three courses of chemotherapy without interruption or stop. After chemotherapy, the objective response rate (ORR) was 45.83%, and the clinical benefit rate (CBR) was 93.75%. Most of the adverse reactions of chemotherapy were grade I-II, and the symptoms were relieved after the symptomatic treatment, and the patients could tolerate it. There was no significant difference between the two groups (P>0.05). The main postoperative complications of the two groups were incision infection, lung infection, abdominal infection, intestinal obstruction, anastomotic leakage, lower extremity deep vein thrombosis, and gastric emptying disorder. The incidence of postoperative complications in the study group was 20.83%, no significant difference compared with 25.00% in the control group (P>0.05). The removal rate of R0 in the study group was 81.25%, significantly higher than that in the control group (45.83%) (P<0.05). The 1-year, 2-year and 3-year survival rates of the study group were higher than those of the control group, the difference was statistically significant (P<0.05). Conclusion: Neoadjuvant chemotherapy before laparoscopic resection of advanced gastric cancer can improve the resection rate of R0 and the survival rate of the patients, which has no significant effect on the perioperative indexes and complications of laparoscopic surgery.

Key words： advanced gastric cancer laparoscopy neoadjuvant chemotherapy efficacy prognosis

Received: 15 March 2019

Corresponding Authors: LIU Qi. E-mail: liuqi11223@126.com

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	LIU Qi
	YUAN Bo
	DU Ying-lian

Cite this article:

LIU Qi,YUAN Bo,DU Ying-lian. The Effect of Neoadjuvant Chemotherapy Combined with Laparoscopic Surgery on the Prognosis of Advanced Gastric Cancer[J]. Chinese Journal of Biomedical Engineering, 2019, 28(2): 47-56.

URL:

http://manu32.magtech.com.cn/Jwk_zgswyx_en/EN/ OR http://manu32.magtech.com.cn/Jwk_zgswyx_en/EN/Y2019/V28/I2/47

[1] Wang FH, Shen L, Li J, et al.The Chinese Society of Clinical Oncology (CSCO): clinical guidelines for the diagnosis and treatment of gastric cancer[J]. Cancer Commun (Lond), 2019,39: 10.
[2] Chen W, Zheng R, Baade PD, et al.Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016,66(2): 115-132.
[3] Torre LA, Bray F, Siegel RL, et al.Global cancer statistics, 2012[J]. CA Cancer J Clin, 2015,65(2): 87-108.
[4] Pasechnikov V, Chukov S, Fedorov E, et al.Gastric cancer: prevention, screening and early diagnosis[J]. World J Gastroenterol, 2014,20(38):13842-13862.
[5] Tong DF, Liu JW, Sun L, et al.Laparoscopic-assisted D2 gastrectomy for advanced gastric cancer: a clinical study[J]. Chinese Journal of General Surgery, 2015,24(8): 1201-1204.
[6] Zheng CH, Lu J, Huang CM, et al.Treatment of locally advanced gastric cancer with the XELOX program of neoadjuvant chemotherapy combined with laparoscopic surgery: the experience in China[J]. Hepatogastroenterology, 2014,61(135): 1876-1882.
[7] Chen L, Lin HZ, Jiang XJ, et al.Effects of mFOLFOX7 neoadjuvant chemotherapy protocol on advanced gastric cancer[J]. Chinese Journal of Current Advances in General Surgery, 2010,13(1):31-34.
[8] Liu X, Han ZY, Wang YZ, et al.Clinical efficacy of laparoscopic and open radical gastrectomy for gastric cancer and its effect on tumor micrometastasis and gastrointestinal hormone levels[J]. Chinese Journal of General Surgery, 2017,26(12): 1637-1641.
[9] Kim HS, Kim JW, Kim JH, et al.Single-lesion measurement per organ for assessing tumor response in advanced gastric cancer[J]. Oncology, 2015,88(2): 69-75.
[10] Ozdemir N, Abali H, Vural M, et al.Docetaxel, cisplatin, and fluorouracil combination in neoadjuvant setting in the treatment of locally advanced gastric adenocarcinoma: Phase II NEOTAX study[J]. Cancer Chemother Pharmacol, 2014,74(6): 1139-1147.
[11] Liu HB.Laparoscopic gastrectomy for gastric cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic edition) , 2013,12(1):64-64.
[12] Ji JF, Ji X.Current status and prospects of neoadjuvant chemotherapy for gastric cancer[J]. Chinese Journal of Clinical Oncology, 2012,39(20):1458-1461.
[13] Aoyama T, Yoshikawa T.Adjuvant therapy for locally advanced gastric cancer[J]. Surg Today, 2017,47(11): 1295-1302.
[14] Song Z, Wu Y, Yang J, et al.Progress in the treatment of advanced gastric cancer[J]. Tumour Biol, 2017,39(7): 1010428317714626.
[15] Yang K, Choi YY, Zhang WH, et al.Strategies to improve treatment outcome in gastric cancer: a retrospective analysis of patients from two high-volume hospitals in Korea and China[J]. Oncotarget, 2016,7(28): 44660-44675.
[16] Cardona K, Zhou Q, Gönen M, et al.Role of repeat staging laparoscopy in locoregionally advanced gastric or gastroesophageal cancer after neoadjuvant therapy[J]. Ann Surg Oncol, 2013,20(2): 548-554.
[17] Zhang YJ, Zhou J, Ahebietike, et al. Fast-track surgery in neoadjuvant chemotherapy combined with laparoscopic D2radical gastrectomy for advanced gastric cancer[J]. Journal of Chinese Practical Diagnosis and Therapy, 2018,32(5): 57-60.
[18] Hu JK, Zhang WH, Chen XZ.Laparoscopic gastrectomy combined with neoadjuvant chemotherapy for gastric cancer patients: from the view of the CLASS-03a trial[J]. Chinese Journal of Gastrointestinal Surgery, 2018,21(2):138-142.
[19] Mansour JC, Tang L, Shah M, et al.Does graded histologic response after neoadjuvant chemotherapy predict survival for completely resected gastric cancer[J]? Ann Surg Oncol, 2007,14(12): 3412-3418.
[20] Kim MS, Lim JS, Hyung WJ, et al.Neoadjuvant chemoradiotherapy followed by D2 gastrectomy in locally advanced gastric cancer[J]. World J Gastroenterol, 2015,21(9): 2711-2718.
[21] Zhao Q, Li Y, Tan BO, et al.Effects of XELOX regimen as neoadjuvant chemotherapy on radical resection rate and prognosis in patients with advanced gastric cancer[J]. Chinese Journal of Oncology, 2013,35(10):773-777.
[22] Bian YH, Cao H, Yu FR, et al.Effects of preoperative arterial infusion chemotherapy with oxaliplatin and 5-FU for patients with advanced gastric cancer[J]. Chinese Journal of General Surgery, 2009,18(9): 955-959.
[23] Li Z, Shan F, Ying X, et al.Laparoscopic or open distal gastrectomy after neoadjuvant chemotherapy for advanced gastric cancer: study protocol for a randomised phase II trial[J]. BMJ Open, 2018,8(8): e021633.
[24] Zhang JB.Therapeutic effects of neoadjuvant chemotherapy combined with laparoscopic surgery on advanced gastric carcinoma and its effects on patient’s immune function at peroperative period[J]. Hebei Medical Journal, 2015,37(19): 2904-2907.
[25] Wang ST, Zhu ZH, Li XY, et al.Advances and Clinical Efficacy Evaluation Method on Neoadjuvant Chemotherapy in Patients with Gastric Cancer[J]. Chinese Journal of Bases And Clinics in General Surgery, 2010,17(2): 200-204.
[26] Han RB, Zhang YF.Efficacy and safety of neoadjuvant chemotherapy combined with laparoscopic radical gastrectomy for advanced gastric cancer[J]. Modern Digestion & Intervention, 2017,22(2): 245-247.
[27] Yang XY, Zhao XJ.Effect of neoadjuvant chemotherapy combined with laparoscopy in the treatment of advanced gastric cancer and the expression levels of MMP, PG and VEGF[J]. Chinese Journal of Integrated Traditional and Western Medicine on Digestion, 2019, 27(1): 62-66.
[28] Rao Y, Luo Q, Xu P, et al.Perioperative characteristics of patients with locally advanced gastric cancer receiving preoperative neoadjuvant chemotherapy[J]. Journal of Third Military Medical University, 2018,40(22): 2098-2101.
[29] Shuai XM, Gao JB, Liu XH, et al.Clinical efficacy of neoadjuvant chemotherapy combined with laparoscopy-assisted radical gastrectomy for advanced gastric cancer[J]. Chinese Journal of Digestive Surgery, 2016,15(3): 241-246.
[30] Wang J, Han XP, Su L, et al.Comparision of the recent treatment effect between laparoscopic and open surgery following neoadjuvant chemortherapy for advanced gastric cancer[J]. Journal of Modern Oncology, 2014,22(11): 2632-2635.
[31] Kim MS, Lim JS, Hyung WJ, et al.Neoadjuvant chemoradiotherapy followed by D2 gastrectomy in locally advanced gastric cancer[J]. World J Gastroenterol, 2015,21(9): 2711-2718.
[32] Wu MQ, Zhou XK, Li P, et al.Neoadjuvant Chemotherapy Combined with Laparoscopy-assisted Surgery for Advanced Proximal Gastric Cancer: a Clinical Research of 36 Cases[J]. Chinese Journal of Minimally Invasive Surgery, 2014,14(2): 109-111.
[33] Kim JS, Kang SH, Moon HS, et al.Clinical Outcome of Doublet and Triplet Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer[J]. Korean J Gastroenterol, 2016,68(5): 245-252.
[34] Barone C, Cassano A, Pozzo C, et al.Long-term follow-up of a pilot phase II study with neoadjuvant epidoxorubicin, etoposide and cisplatin in gastric cancer[J]. Oncology, 2004,67(1): 48-53.
[35] Wagner AD, Syn NLX, Moehler M, et al. Chemotherapy for advanced gastric cancer [J]. Cochrane Database Syst Rev, 2017, 2017(8): CD004064.
[36] Li Z, Shan F, Wang Y, et al.Laparoscopic versus open distal gastrectomy for locally advanced gastric cancer after neoadjuvant chemotherapy: safety and short-term oncologic results[J]. Surg Endosc, 2016, 30(10): 4265-4271.