BackgroundGiven the expanding clinical applications of laparoscopic surgery and neoadjuvant chemotherapy in advanced gastric cancer treatment, there is an emerging need to summarize the few evidences that evaluated the safety and efficacy of laparoscopic versus open gastrectomy in patients with advanced gastric cancer (AGC) following neoadjuvant chemotherapy (NAC).MethodsFrom January 1 to 2, 2021, we searched Ovid Embase, PubMed, Cochrane central register Trials (Ovid), and web of science to find relevant studies published in English, and two authors independently performed literature screening, quality assessment of the included studies, data extraction, and data analysis. This study was registered with PROSPERO (CRD42021228845).ResultsThe initial search retrieved 1567 articles, and 6 studies were finally included in the meta-analysis review, which comprised 2 randomized control trials and 4 observational studies involving 288 laparoscopic gastrectomy (LG) and 416 open gastrectomy (OG) AGC patients treated with NAC. For intraoperative conditions, R0 resection rate, blood transfusion, intraoperative blood loss, number of lymph nodes dissected, proximal margin, and distal margin were comparable between LG group and open OG group. For postoperative short-term clinical outcomes, LG has significantly less postoperative complications (OR = 0.65, 95%CI: 0.42–1.00, p = 0.05) and shorter postoperative time to first aerofluxus (WMD = -0.57d, 95%CI: -0.89–0.25, p = 0.0004) than OG, and anastomotic leakage, pulmonary infection, pleural effusion, surgical site infection, thrombosis, intestinal obstruction, peritoneal effusion or abscess formation, postoperative time to first defecation, postoperative time to first liquid diet, and postoperative length of stay were comparable between the two groups. For postoperative survival outcomes, there were no significant differences in disease-free survival (DFS) and overall survival (OS) between the two groups.ConclusionThe available evidences indicated that LG is an effective and feasible technology for the treatment of AGC patients treated with NAC, and LG patients have much less postoperative complications and faster bowel function recovery than OG patients.Systematic Review RegistrationPROSPERO database (identifier, CRD42021228845).
LN dissection is essential for accurately staging and improving GC patient prognosis. However, the compliance rate for No. 12a LND in practice is low, and its necessity is controversial. Data from GC patients who underwent total gastrectomy (TG)/distal gastrectomy (DG) plus D2 lymphadenectomy between January 2000 and December 2017 at West China Hospital, Sichuan University were reviewed. No. 12a LND noncompliance’s effect on the long-term prognosis of patients with GC after D2 gastrectomy was explored. Of the 2788 patients included, No. 12a LND noncompliance occurred in 1753 patients (62.9%). Among 1035 patients with assessable LNs from station 12a, 98 (9.5%) had positive LNs detected at station 12a. No. 12a LN metastasis patients (stage IV not included) had significantly better overall survival (OS) than TNM stage IV patients (p = 0.006). Patients with No. 12a LND compliance had a significantly higher OS than those without, both before (p < 0.001) and after (p < 0.001) PSM. Cox multivariate analysis confirmed that No. 12a LND noncompliance was an independent prognostic factor before (HR 1.323, 95% CI 1.171–1.496, p < 0.001) and after (HR 1.353, 95% CI 1.173–1.560, p < 0.001) PSM. In conclusion, noncompliance with No. 12a LND compromised the long-term survival of patients who underwent D2 gastrectomy for GC.
Objective:The efficacy of neoadjuvant chemotherapy (NAC) among advanced gastric cancer (GC) is still a controversial issue. Our aim is to find the factors associated with chemosensitivity of NAC, and provide optimal therapeutic strategy for GC patients who received NAC.Methods: Clinical information was collected from 230 gastric cancer patients who received NAC in West China Hospital from January 2016 to December 2020. LASSO logistic regression analysis was performed to find the possible predictors which a nomogram model for prediction of response to NAC was based on.Results: A total of 230 patients were finally included in this study, including 154 males (67.0%) and 76 females (33.0%). And mean age was (59.37±10.60) years, ranging from 24 to 80 years. Based on the TRG standard, there were 95 cases in the obvious response group (grade 0 or grade 1) and 135 cases in the non-obvious response group (grade 2 or grade 3), and the obvious response rate was 41.3%. LASSO analysis showed that four risk factors that were significantly related to the efficacy of NAC, which included tumor location (P<0.001) , histological differentiation (P=0.001), clinical T stage (P=0.008) , CA724 (P=0.008) . The C-index for prediction nomogram was 0.806, and the calibration curve revealed the predicted value exhibited good agreement with the actual value, decision curve analysis showed that the nomogram had a good value in clinical application.Conclusions: The nomogram which combined tumor location, histological differentiation,clinical T stage and CA724 showed satisfactory predictive power to response of NAC, and could be used by gastrointestinal surgeons to identify optimal treatment strategy for advanced gastric cancer patients.
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