Impact of perioperative treatment on survival of resectable gastric cancer patients after D2 lymphadenectomy: a single European centre propensity score matching analysis

Abstract

Background To determine the effects of perioperative treatment of gastric cancer patients, we conducted an analysis with propensity score matched patient groups to determine the role of perioperative chemotherapy in patients after D2 lymphadenectomy. Patients and methods From our database of 1563 patients, 482 patients were selected with propensity score matching and divided into two balanced groups: 241 patients in the surgery only group and 241 patients in the perioperative group. The long-term results of treatment were compared between the two groups. Results Most of the included patients received radio-chemotherapy with capecitabine (n = 111; 46%) and perioperative chemotherapy with epirubicin, oxalliplatin and capecitabine (n = 91; 37.7%). 92.9% of the patients received a D2 lymph node dissection. Perioperative morbidity was similar between surgery only (18.3%) and perioperative treatment groups (20.7%) (p = 0.537). The perioperative mortality was not influenced by perioperative treatment. A pathological response was observed in 12.5% of patients. The overall 5-year and median survivals were significantly higher in the perioperative treatment group (50.5%; 51.7 moths) compared to surgery only group (41.8%; 34.9 months; p = 0.038). The subgroup analysis revealed that only patients with the TNM stages T3 (p = 0.028), N2 (p = 0.009), N3b (p = 0.043), and UICC stages IIIb (p = 0.003) and IIIc (p = 0.03) significantly benefit from perioperative treatment. Conclusions Perioperative treatment in radically resected gastric cancer patients after D2 lymphadenectomy was beneficial in stages IIIb and IIIc. The effects of perioperative treatment in lower stages could be negated by the effects of the radical surgery in lower stages and in higher stages by the biology of the disease.

Radiomics model based on preoperative 18F-fluorodeoxyglucose PET predicts N2-3b lymph node metastasis in gastric cancer patients

“…A Dutch trial demonstrated that GC patients with N2 stage, who underwent D2 dissection, had a survival benefit superior to those who underwent D1 dissection [10]. Furthermore, the survival benefit for perioperative treatment in the TNM stages T3, N2 and N3b patients after D2 lymphadenectomy is affirmed again by Jagric et al [24]. In addition, the application of preoperative NAC in GC patients has drawn increased attention in recent years.…”

“…Furthermore, the survival benefit for perioperative treatment in the TNM stages T3, N2 and N3b patients after D2 lymphadenectomy is affirmed again by Jagric et al . [24]. In addition, the application of preoperative NAC in GC patients has drawn increased attention in recent years.…”

The outcomes of laparoscopic omentum-preserving gastrectomy compared to open surgery with omentectomy in gastric cancer patients: a propensity score matched study of 249 UICC stage 0–IV gastric cancer patients

“…The regimen used for perioperative treatment was 5-FU–leucovorin–oxaliplatin–docetaxel (FLOT) four cycles pre- and four cycles post-operative. The precise doses for the regiment are provided in the as described elsewhere [ 9 , 10 ]. The inclusion criteria for this study were adenocarcinoma diagnosed between 2015 and 2022, UICC tumor stages 0-IV, and complete follow-up.…”

The results of 100 consecutive laparoscopic omentum-sparing gastric cancer resections with D2 lymphadenectomy

“…Severe renal impairment (calculated creatinine clearance less than 30 mL/min) suspected dihydro pyrimidine dehydrogenase (DPD) de ciency. Perioperative treatment was administered as described elsewhere [10]. All patient characteristics, operations, and tumor characteristics were prospectively stored in the hospital database.…”