Impact of neoadjuvant chemotherapy on surgical and pathological results of gastric cancer patients: A case‐control study

Charruf, Amir Zeide; Ramos, Marcus Fernando Kodama Pertille; Pereira, Marina Alessandra; Dias, André Roncon; Castria, Tiago Biachi De; Zilberstein, Bruno; Cecconelo, Ivan; Ribeiro, Ulysses

doi:10.1002/jso.25839

Cited by 24 publications

(46 citation statements)

References 31 publications

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“…This can be due to the suboptimal reliability of clinical staging of gastric cancer, with an overall CT scan accuracy for T staging ranging from 43% to 82% 5 and an overall EUS accuracy for T and N staging of 46.2% and 66.7%, respectively. In the studies reporting specific clinical stages, 6,10,36 72%–93% of patients had cT3/4 and 55‐80% had cN + . However, few studies reported the distribution of the patients between cStage II and cStage III 10 …”

Section: Discussionmentioning

confidence: 99%

“…Although surgery remains the only curative treatment for gastric cancer in the last decades, several multimodal approaches have been developed to improve long‐term survival. Among them, perioperative chemotherapy (PC) has gained growing attention due to its potential to improve R0 resection and survival rates 5,6 . PC is administered both before, so‐called neoadjuvant chemotherapy (NACT), and after curative surgery so‐called adjuvant chemotherapy (ACT).…”

Section: Introductionmentioning

confidence: 99%

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Prognostic value of pathological tumor regression grade in locally advanced gastric cancer: New perspectives from a single‐center experience

Lombardi

Mazzola

Achilli

et al. 2021

Journal of Surgical Oncology

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Background and Objective Perioperative chemotherapy (PC) with radical surgery represents the gold standard of treatment for resectable advanced gastric cancer (GC). The prognostic value of pathological tumor regression grade (TRG) induced by neoadjuvant chemotherapy (NACT) is not clearly established. This study aimed to investigate the correlation between TRG and survival in GC. Methods Patients affected by advanced GC undergoing PC and radical surgery were considered. TRG was assessed for each patient according to Becker's grading system. The correlation between TRG and survival was investigated. Results One‐hundred patients were selected; 25 showed a good response (GR) (TRG 1a/1b), while 75 had a poor response (PR) (TRG 2/3) to NACT. GR patients showed better disease‐free survival (DFS) (52 vs. 19 months, p < .001) and disease‐specific survival (DSS) (57 vs. 25 months, p < .0001) when compared to PR patients. On univariate analysis, TRG, lymph node ratio (LNR), tumor size, grading, and post‐neoadjuvant therapy TNM stage were significantly correlated with survival. On multivariate analysis, TRG, LNR and tumor size were independent prognostic factors for DFS and DSS. Conclusions TRG, LNR, and tumor size are independent prognostic factors for DFS and DSS in patients with advanced GC undergoing NACT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognostic value of pathological tumor regression grade in locally advanced gastric cancer: New perspectives from a single‐center experience

Lombardi

Mazzola

Achilli

et al. 2021

Journal of Surgical Oncology

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“…In the ERAS guidelines for gastric cancer resection, the strength of recommendation for each ERAS measure is buttressed by high levels of evidence; however, NAC has never been included in the ERAS protocol and some studies purposefully excluded patients who received NAC [17,18]. A large body of evidence con rms that NAC can not only effectively downgrade advanced gastric cancer after a patient undergoes a palliative operation to achieve R0 resection, but also signi cantly improves long-term survival by reducing the recurrence of cancer [19,20].…”

Section: Discussionmentioning

confidence: 99%

Integration of Neoadjuvant Chemotherapy into the ERAS protocol for Patients with Advanced Gastric Cancer

Bao¹,

Dai²,

Zhao³

et al. 2021

Preprint

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Objective We integrated neoadjuvant chemotherapy (NAC) into the protocol for Enhanced Recovery After Surgery (ERAS) in the management of gastric cancer. This study was aimed at investigating the feasibility and effectiveness of this combined approach. Methods A retrospective cohort study was conducted on patients with gastric cancer undergoing cancer treatment at our Department from January 2016 to June 2019. All patients were compliant with the ERAS protocol perioperatively and were divided into an ERAS group and an ERAS + NAC group for the study. The following parameters were compared between the two groups: TNM staging, the choice of the surgical approach, estimated blood loss, operating time, placement of drainage and catheter, the volume of fluid resuscitation in surgery, the volume of fluid resuscitation on the first postoperative day, time to postoperative ambulation, time to first postoperative flatulence, time to first clear liquid diet, time to puree and soft food diet, time of catheter removal, length of hospitalization after surgery, length of hospitalization, complications, mortality, and 30-day readmission rate. Results This study involved 198 patients who were separated into an ERAS group with 143 patients and an ERAS + NAC group with 55 patients. In comparison with the ERAS group, patients in the ERAS + NAC group were not only pathologically diagnosed with later TNM-stage cancers but were also more likely to undergo total gastrectomy. Further comparison revealed no significant differences in all perioperative parameters related to ERAS. In the ERAS group, the length of hospitalization after surgery was 7.5 ± 5.4 days with a range of 3 to 50 days, the length of hospitalization was 12.5 ± 5.5 days with a range of 9 to 56 days, the incidence rate of complications was 11.2%, and the 30-day readmission rate was zero. In the ERAS + NAC group, the LOHAS was 6.9 ± 3.2 days (4–16 days), the LOH was 11.8 ± 3.1 days (5–21 days), and the complication rate was 10.9%. Both groups had zero 30-day readmission rates and zero deaths. Conclusion The ERAS protocol can be feasibly and effectively applied to gastric cancer patients with later TNM stages. Moreover, NAC can be integrated into the ERAS protocol for patients with advanced gastric cancer.

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Section: Discussionmentioning

confidence: 99%

Integration of Neoadjuvant Chemotherapy into the ERAS protocol for Patients with Advanced Gastric Cancer

Bao

Dai

Zhao

et al. 2020

Preprint

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Objective We integrated neoadjuvant chemotherapy (NAC) into the protocol for Enhanced Recovery After Surgery (ERAS) in the management of gastric cancer. This study was aimed at investigating the feasibility and effectiveness of this combined approach. Methods A retrospective cohort study was conducted on patients with gastric cancer undergoing cancer treatment at our Department from January 2016 to June 2019. All patients were compliant with the ERAS protocol perioperatively and were divided into an ERAS group and an ERAS + NAC group for the study. The following parameters were compared between the two groups: TNM staging, the choice of the surgical approach, estimated blood loss, operating time, placement of drainage and catheter, the volume of fluid resuscitation in surgery, the volume of fluid resuscitation on the first postoperative day, time to postoperative ambulation, time to first postoperative flatulence, time to first clear liquid diet, time to puree and soft food diet, time of catheter removal, length of hospitalization after surgery, length of hospitalization, complications, mortality, and 30-day readmission rate. Results This study involved 198 patients who were separated into an ERAS group with 143 patients and an ERAS + NAC group with 55 patients. In comparison with the ERAS group, patients in the ERAS + NAC group were not only pathologically diagnosed with later TNM-stage cancers but were also more likely to undergo total gastrectomy. Further comparison revealed no significant differences in all perioperative parameters related to ERAS. In the ERAS group, the length of hospitalization after surgery was 7.5±5.4 days with a range of 3 to 50 days, the length of hospitalization was 12.5±5.5 days with a range of 9 to 56 days, the incidence rate of complications was 11.2%, and the 30-day readmission rate was zero. In the ERAS + NAC group, the LOHAS was 6.9±3.2 days (4-16 days), the LOH was 11.8±3.1 days (5-21 days), and the complication rate was 10.9%. Both groups had zero 30-day readmission rates and zero deaths. Conclusion The ERAS protocol can be feasibly and effectively applied to gastric cancer patients with later TNM stages. Moreover, NAC can be integrated into the ERAS protocol for patients with advanced gastric cancer.

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Impact of neoadjuvant chemotherapy on surgical and pathological results of gastric cancer patients: A case‐control study

Cited by 24 publications

References 31 publications

Prognostic value of pathological tumor regression grade in locally advanced gastric cancer: New perspectives from a single‐center experience

Prognostic value of pathological tumor regression grade in locally advanced gastric cancer: New perspectives from a single‐center experience

Integration of Neoadjuvant Chemotherapy into the ERAS protocol for Patients with Advanced Gastric Cancer

Integration of Neoadjuvant Chemotherapy into the ERAS protocol for Patients with Advanced Gastric Cancer

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