Impact of neoadjuvant therapy followed by laparoscopic radical gastrectomy with D2 lymph node dissection in Western population: A multi‐institutional propensity score‐matched study

Abstract

Background and Objectives: 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: 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: 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 This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

“Impact of neoadjuvant therapy followed by laparoscopic radical gastrectomy with D2 lymph node dissection in Western population: A multi‐institutional propensity score matched study”—Authors' reply

“…However, D2 lymph-node dissection was performed in 97.9% in both groups as the surgeons involved were considered enough skilled in laparoscopy and surgical oncology for gastric cancer. 2,9 In conclusion, our article does not aim to question the usefulness of NAT. We hypothesize that a tailored approach can offer better…”

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We read with interest the letter by Graziosi et al 1 regarding our published article. 2 We would like to provide a point-by-point response to their "dogmatic" sentences and to better clarify our conclusions.1) Authors claim "Although indications to neoadjuvant chemotherapy (NAC) for locally advanced gastric cancer (lAGC) are still debated, nowadays their importance has been increasingly recognized. "| © 2022 Wiley Periodicals LLC outcomes than indiscriminate use.

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“…We read with interest the letter by Graziosi et al 1 regarding our published article. 2 We would like to provide a point-by-point response to their "dogmatic" sentences and to better clarify our conclusions.…”

“…This is exactly what we have done: in our series, poor short-term outcomes are more evident in patients over 60 years old receiving NAT. 2 4) They more claim: "Analyzing survival outcomes, we would suggest stratifying patients according to Lauren histotype (intestinal vs. diffuse type), location (stomach cancer vs. cardias one), and different chemotherapic schemes before asserting that NAC is associated with poor survival outcomes." We appreciate the suggestion, however we never asserted that NAC is associated with poor survival outcomes.…”

Reply to: “Impact of neoadjuvant therapy followed by laparoscopic radical gastrectomy with D2 lymph node dissection in Western population: a multi‐institutional propensity score matched study”

“…We appreciate with interest the paper written by Bracale et al entitled "Impact of neoadjuvant therapy followed by laparoscopic radical gastrectomy with D2 lymph node dissection in Western population: a multi-institutional propensity score matched study". 1 Although indications to neoadjuvant chemotherapy (NAC) for locally advanced gastric cancer (lAGC) are still debated, nowadays their importance has been increasingly recognized.…”