Predictors of pathological response and tumor regression following neoadjuvant therapy in advanced gastric cancer patients.

206 Background: Neoadjuvant chemotherapy (NACT) has became the standard approach for patients with advanced gastric cancer. Clinicopathological characteristics can be utilized to evaluate the effect of NACT, and may be a useful tool to identify responsive patients. Methods: We retrospectively reviewed all patients with GC treated with NACT and R0 resection between 2009 and 2015 from a prospective collected database. Histopathological response to the treatment was graded from 0% to 100% and the clinicopathological characteristics assessed to identify predictors of tumor response. A threshold of 50% histopathological response was used for the analysis. Results: NACT was performed in 45 patients. Cisplatin-irinotecan therapy was used in 64.4% of patients and 11 (24.4%) tumors were located in the proximal stomach. Ten (22.2%) patients demonstrated a tumor regression of at least 50% and one patient had complete response. The mean number of lymph node retrieved was 38.1 and 66.7% patients had lymph node metastasis (LNM). Factors associated with > 50% of response by univariate analyses included lower neutrophil-lymphocyte ratio (NLR) ( p = 0.035), diffuse/mixed Lauren type ( p = 0.007), lower depth of tumor invasion ( p = 0.043) and non cisplatin-irinotecan therapy (p = 0.01). A slight tendency of poorly differentiated tumors respond better to NACT than differentiated type was observed ( p = 0.05). There was no significant difference regarding the presence of mucin, calcification and/or necrosis and the tumor response. Multivariate analysis identified NLR and diffuse/mixed tumors as independent predictors of pathologic response. Median follow-up for all patients was 26.5 months and recurrence-free survival (RFS) rate was 74.3% and 60% for patients with > 50% and < 50% of response, respectively ( p= 0.08). RFS was significantly different in patients without LNM compared to patients who have LNM (100% vs. 55.2%, p = 0.01), and in patients with fibroinflammatory/inflammatory stroma infiltration compared to patients with only fibrotic stroma (80% vs. 53.3%, p = 0.015). Conclusions: Diffuse/mixed histopathological type and lower NLR are independently predictors of tumor response after NACT.

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Long-term outcomes of omentum-preserving versus resecting gastrectomy for locally advanced gastric cancer with propensity score analysis

Scientific Reports ◽

10.1038/s41598-020-73367-8 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Yusuke Sakimura ◽

Noriyuki Inaki ◽

Toshikatsu Tsuji ◽

Shinichi Kadoya ◽

Hiroyuki Bando

Keyword(s):

Gastric Cancer ◽

Propensity Score ◽

Advanced Gastric Cancer ◽

Missing Values ◽

Propensity Score Analysis ◽

Locally Advanced ◽

R0 Resection ◽

Significant Difference ◽

First Recurrence ◽

The Impact

Abstract Omentectomy is conducted for advanced gastric cancer (AGC) patients as radical surgery without an adequate discussion of the effect. This study was conducted to reveal the impact of omentum-preserving gastrectomy on postoperative outcomes. AGC patients with cT3 and 4 disease who underwent total or distal gastrectomy with R0 resection were identified retrospectively. They were divided into the omentum-preserved group (OPG) and the omentum-resected group (ORG) and matched with propensity score matching with multiple imputation for missing values. Three-year overall survival (OS) and 3-year relapse-free survival (RFS) were compared, and the first recurrence site and complications were analysed. The numbers of eligible patients were 94 in the OPG and 144 in the ORG, and after matching, the number was 73 in each group. No significant difference was found in the 3-year OS rate (OPG: 78.9 vs. ORG: 78.9, P = 0.54) or the 3-year RFS rate (OPG: 77.8 vs. ORG: 68.2, P = 0.24). The proportions of peritoneal carcinomatosis and peritoneal dissemination as the first recurrence site and the rate and severity of complications were similar in the two groups. Omentectomy is not required for radical gastrectomy for AGC.

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Duration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved

Frontiers in Oncology ◽

10.3389/fonc.2021.775166 ◽

2021 ◽

Vol 11 ◽

Author(s):

Zining Liu ◽

Yinkui Wang ◽

Fei Shan ◽

Xiangji Ying ◽

Yan Zhang ◽

...

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Cox Regression ◽

Locally Advanced ◽

R0 Resection ◽

Perioperative Chemotherapy ◽

Tree Model ◽

Less Is More ◽

Locally Advanced Gastric Cancer ◽

Significant Difference

BackgroundsPerioperative chemotherapy (PEC) and neoadjuvant chemotherapy (NAC) have become a vital part of locally advanced gastric cancer (LAGC) treatment, but the optimal duration of PEC has not been studied. The aim of this study was to demonstrate the possibility of duration reduction in PEC in the adjuvant chemotherapy (AC) phase for ypN0 patients.MethodsWe included LAGC patients who achieved ypN0 after NAC in our institution from 2005 to 2018. The risk/benefit of AC and other covariates were majorly measured by overall survival (OS) and progression-free survival (PFS). We developed a survival-tree-based model to determine the optimal PEC duration for ypN0 patients in different classes.ResultsA total of 267 R0 resection patients were included. There were 55 patients who did not receive AC. The 5-year OS was 74.34% in the non-AC group and 83.64% in the AC group with a significant difference (p = 0.012). Multivariate Cox regression revealed that both AC (AC vs. non-AC: HR, 0.49; 95%CI, 0.27–0.88; p = 0.018) and ypT stages (ypT3-4 vs. ypT0-2: HR, 2.00; 95%CI, 1.11–3.59; p = 0.021) were significant protective/risk factors on patients OS and PFS. A decision tree model for OS indicated an optimal four to six cycles of PEC, which was recommended for ypT0-2N0 patients, while a minimum of five PEC cycles was recommended for ypT3-4N0 patients.ConclusionAC treatment is still necessary for ypN0. The duration reduction could be applied for the ypT0-2N0 stage patients but may not be suitable for higher ypT stages and beyond. A multicenter-based study is required.

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Neoadjuvant Docetaxel, Oxaliplatin, Leucovorin, and 5-Fluorouracil (FLOT) Versus S-1 plus Oxaliplatin (SOX) for Patients with Locally Advanced Gastric Cancer

10.1101/2020.06.21.20136887 ◽

2020 ◽

Author(s):

Birendra Kumar Sah ◽

Benyan Zhang ◽

Huan Zhang ◽

Jian Li ◽

Fei Yuan ◽

...

Keyword(s):

Gastric Cancer ◽

Neoadjuvant Chemotherapy ◽

Advanced Gastric Cancer ◽

Tumor Regression ◽

Locally Advanced ◽

Pathological Response ◽

Clinicopathological Parameters ◽

Regression Grading ◽

Locally Advanced Gastric Cancer ◽

Significant Difference

AbstractBackgroundDespite growing trends of neoadjuvant chemotherapy for advanced gastric cancer, there is still no consensus of optimal regimens between East and West countries. Neoadjuvant chemotherapy with docetaxel, oxaliplatin, fluorouracil, and Leucovorin (FLOT) regimen has shown promising results in terms of pathological response and survival rate. However, S-1 plus oxaliplatin (SOX) is a more favorable chemotherapy regimen in Eastern countries. We conducted this study to evaluate the safety and efficacy of both regimens, and to explore a suitable regimen for Chinese patients.MethodsPatients with locally advanced gastric cancer(LAGC) were 1:1 randomly assigned to receive either 4 cycles of FLOT or 3 cycles of SOX regimen before curative gastrectomy. The primary endpoint was the comparison of complete or sub-total tumor regression grading (TRG1a+ TRG1b) in the primary tumor.ResultsAltogether 74 cases enrolled between August 2018 and March 2020. All 74 randomly assigned cases were considered as intention-to-treat (ITT) population, and the 55 patients who completed the planned chemotherapy plus surgery were considered as per protocol (PP) population. There was no significant difference in pre-treatment clinicopathological parameters between the FLOT and SOX group(p>0.05). There was no significant difference in adverse effects or postoperative morbidity and mortality between two groups (p>0.05). Similarly, there was no significant difference in the proportion of tumor regression grading between the FLOT and SOX group(p>0.05). In the ITT population, complete or sub-total TRG was 20.0 % in FLOT versus 32.4 % in the SOX group (p>0.05).ConclusionsOur study demonstrates that FLOT and SOX regimens are similarly effective for locally advanced gastric cancer patients in terms of clinical downstaging and pathological response. Both regimens were well-tolerated in this study. A large scale phase 3 randomized controlled trial is necessary to validate this result.

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ROLE OF COMPUTED TOMOGRAPHY WITH PNEUMOGASTROGRAPHY IN DETERMINING THE REGRESSION GRADE OF LOCALLY ADVANCED GASTRIC CANCER AFTER NEOADJUVANT CHEMOTHERAPY

Siberian Journal of Oncology ◽

10.21294/1814-4861-2021-20-5-18-30 ◽

2021 ◽

Vol 20 (5) ◽

pp. 18-30

Author(s):

I. D. Amelina ◽

A. M. Karachun ◽

D. V. Nesterov ◽

L. N. Shevkunov ◽

A. S. Artemieva ◽

...

Keyword(s):

Gastric Cancer ◽

Computed Tomography ◽

Lymph Node ◽

Advanced Gastric Cancer ◽

Tumor Response ◽

Response Rate ◽

Locally Advanced ◽

Imaging Biomarkers ◽

Locally Advanced Gastric Cancer ◽

Regression Grade

Introduction. A multimodal approach to the treatment of locally advanced gastric cancer with the addition of systemic or local treatment methods, such as chemotherapy and radiation therapy, reduces the risk of cancer recurrence, thus improving survival of patients. Advances in anticancer therapy dictate the need to develop systems for assessing tumor response to new treatment modalities.Material and Methods. The study included 162 patients with locally advanced gastric cancer who received treatment at the N.N. Petrov National Medical Research Center of Oncology from 2015 to 2018. All patients underwent subtotal gastric resection or gastrectomy with lymph node dissection and previously received neoadjuvant polychemotherapy. Patients were in the age range 30 to 80 years old. The tumor pathomorphological response to chemotherapy was assessed in all patients using a pathomorphological response rate system according to the classification of the Japanese Gastric Cancer Association (JGCA, 3rd English edition). All patients underwent computed tomography with pneumogastrography before neoadjuvant chemotherapy and immediately before surgery. For each of 162 patients, 96 qualitative and quantitative biomarkers of tumor and paragastric lymph node imaging were analyzed.Results. The accuracy of determining the tumor response rate using computed tomography with pneumogastrography was 82.6 % for TRG-0/1, 90 % for TRG-1/2, and 88 % for TRG-2/3. Discussion. The tumor pathomorphological response to treatment is a predictor of long-term results; however, it can be assessed only after analyzing the surgical specimen, and this marker cannot be used in inoperable cases and for correction of palliative chemotherapy. The study of imaging biomarkers based on quantitative and qualitative data reflecting the histopathological features of the tumor and lymph nodes can help determine the tumor regression grade and optimize treatment.Conclusion. The proposed algorithm for assessing the response grade of locally advanced gastric cancer to chemotherapy using imaging biomarkers is a promising prognostic marker and requires further study.

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Prognostic value of response assessed by RECIST and WHO criteria to neoadjuvant chemotherapy in locally advanced gastric cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e15647 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e15647-e15647

Author(s):

S. R. Park ◽

J. S. Lee ◽

Y. W. Kim ◽

I. J. Choi ◽

K. W. Ryu ◽

...

Keyword(s):

Gastric Cancer ◽

Neoadjuvant Chemotherapy ◽

Advanced Gastric Cancer ◽

Tumor Size ◽

Tumor Response ◽

Locally Advanced ◽

R0 Resection ◽

Who Criteria ◽

Locally Advanced Gastric Cancer ◽

Response To Neoadjuvant Chemotherapy

e15647 Background: In metastatic gastric cancer, the response to chemotherapy is assessed by RECIST or WHO criteria according to the change of tumor size. There are no data, however, on the usefulness of those criteria in evaluating tumor response in the setting of neoadjuvant chemotherapy. The aim of this study was to evaluate the relationship between tumor response to neoadjuvant chemotherapy-as assessed by RECIST and WHO criteria-and clinical outcome in locally advanced gastric cancer (LAGC) patients. Methods: This study recruited LAGC patients who, from January 2003 through November 2005, entered the neoadjuvant arm of prospective randomized phase II trials comparing neoadjuvant chemotherapy to adjuvant chemotherapy. LAGC was defined as stage III or IV (M0) disease based on computed tomography (CT) according to the Japanese Classification of Gastric Carcinoma. Patients with measurable lesions received 3 cycles of neoadjuvant chemotherapy consisting of docetaxel (36 mg/m2) and cisplatin (40 mg/m2) on days 1 and 8 every 3 weeks, followed by surgery. Results: After chemotherapy, 40 (95%) patients underwent surgery and the remaining 2 patients showed new distant metastasis on CT scan. Thirty-five (83%) patients had curative R0 resection. Twenty-eight (67%) patients had a clinical response to neoadjuvant chemotherapy according to RECIST/WHO criteria. Although R0 resection rate (93% vs 64%, P = 0.03), median relapse-free survival (RFS) (43.2 vs 7.5 months, P = 0.14), and overall survival (OS) (not reached vs 27.0 months, P = 0.10) were better in responders than non-responders, they did not differ significantly in the subgroup that subsequently underwent surgery. When we redefined the decrease in tumor size judged as a response by RECIST (≥60% rather than ≥30%) and WHO (≥75% rather than ≥50%) criteria, response correlated significantly with both RFS (P = 0.03) and OS (P = 0.02). Conclusions: In the neoadjuvant setting, which frequently involves smaller measurable lesions than the metastatic setting, larger changes in tumor size than those specified by RECIST and WHO criteria are needed to predict postoperative outcome. No significant financial relationships to disclose.

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The Safety and Efficacy of Laparoscopic Gastrectomy for Patients with Locally Advanced Gastric Cancer Following Neoadjuvant Chemotherapy

10.21203/rs.3.rs-47635/v1 ◽

2020 ◽

Author(s):

Lihang Liu ◽

Feng Li ◽

Shengtao Lin ◽

Yi Liu ◽

Changshun Yang ◽

...

Keyword(s):

Gastric Cancer ◽

Postoperative Complications ◽

Neoadjuvant Chemotherapy ◽

Advanced Gastric Cancer ◽

Laparoscopic Gastrectomy ◽

Locally Advanced ◽

R0 Resection ◽

Resection Rate ◽

Locally Advanced Gastric Cancer ◽

Significant Difference

Abstract Background: Limited researches focused on the application of laparoscopic gastrectomy (LG) in locally advanced gastric cancer (LAGC) patients following neoadjuvant chemotherapy (NACT). In this study, we aimed at illustrating the surgical and survival outcome of LG in LAGC patients following NACT.Methods: We performed a retrospective study of patients with LAGC who received either LG following NACT or upfront LG at Fujian Provincial Hospital between March 2013 and October 2018. Perioperative parameters, short-term and long-term outcomes were compared. The Kaplan-Meier estimator was used to describe the survival curves, and the differences were examined by the log-rank test.Results: In total, 76 consecutive patients were enrolled into the NACT-LG (41 patients) and LG (35 patients) group, respectively. There was no significant difference between the two groups for baseline characteristics, including age, sex, BMI, Eastern Clinical Oncology Group performance status, tumor size, location, Borrmann type, Lauren type, differentiation, cT stage, and surgical type (all P>0.05). The surgical trauma in terms of incision length and blood loss, and postoperative recovery in terms of first aerofluxus time, first time on liquid diets, drainage duration, and hospital stays were similar between the two groups (all P>0.05). The operation time was significantly longer for NACT-LG than for LG (286.5 vs. 248.9 min, P=0.008). There was no significant difference in surgical morbidity (19.5% vs. 22.9%, P=0.721) between the two groups. No patient died of postoperative complications in the NACT-LG group, and one patient (1/35, 2.9%) died of postoperative complications in the LG group (P=0.461). After NACT, the R0 resection rate was significantly higher (95.1% vs. 77.1%, P=0.049), and metastatic lymph nodes were less for NACT-LG than for LG (1 vs. 8, P=0.001). Compared with the LG group, the NACT-LG group had a significantly better DFS (59.4% vs. 14.4%, P=0.034) and better OS (69.0% vs. 37.4%, P=0.009) at 3 years.Conclusions: NACT does not decrease safety of LG for patients with LAGC and offer higher R0 resection rate and better disease-free and overall survival. For patients with LAGC, LG following NACT should be the priority treatment.

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A phase II study of neoadjuvant chemotherapy with docetaxel, capecitabine and cisplatin (DXP) in patients with advanced unresectable or intra-abdominal metastatic gastric cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.4640 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 4640-4640 ◽

Cited By ~ 2

Author(s):

S. Sym ◽

H. Chang ◽

M. Ryu ◽

J. Lee ◽

T. Kim ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Neoadjuvant Chemotherapy ◽

Advanced Gastric Cancer ◽

Locally Advanced ◽

Metastatic Gastric Cancer ◽

R0 Resection ◽

Paraaortic Lymph Node ◽

Local Invasion ◽

Lymph Node Enlargement

4640 Background: The prognosis of gastric cancer is dismal once R0 resection is impossible due to local invasion or distant metastasis. Previous studies have suggested the possible efficacy of neoadjuvant chemotherapy for the patients with locally advanced gastric cancer (AGC). The aim of the present study was to evaluate the feasibility, the impact on R0 resection of neoadjuvant chemotherapy in locally advanced, unresectable or intra-abdominal metastatic gastric cancer Methods: Patients with advanced gastric cancer, clinically unresectable because of local invasion or intra-abdominal metastasis in paraaortic lymph nodes and/or peritoneum based on CT scan were entered into this study. Preoperative chemotherapy consisted of docetaxel 60 mg/m2 IV on day 1, cisplatin 60 mg/m2 IV on day 1, and capecitabine 1,875 mg/m2/day PO on days 1 - 14 every 21 days. After 2 cycles of chemotherapy, the tumors were evaluated. Unless disease progression was encountered, surgery was performed after total 3 - 6 cycles of chemotherapy and followed by two cycle of adjuvant therapy with the same regimen if R0 resection was done. Results: Total 49 patients were accrued. Among them, 36 (74%) could undergo surgery, and 31 (63%) had R0 resection. R0 resection was possible in 15 (71%) of 21 patients with initially unresectable T4 lesions and in 12 (70%) of 17 patients with paraaortic lymph node enlargement, while only in 3 (42%) of 7 patients with suspicious peritoneal seeding. After a median follow up of 18.2 months for the surviving patients, median overall survival and progression free survival of total enrolled patients were 19 months (95% C.I, 10.5 - 27.4) and 11.6 months (95% C.I, 9.6 - 13.7), respectively. Among 31 patients who underwent R0 resection, median OS was 33.4 months and median PFS was 18.2 months. Major toxicity was neutropenia and grade 3/4 neutropenia occurred in 77% of patients, but there was only 4% of neutropenic fever and no treatment related mortality. Postoperative morbidities were observed in 4 patients. Conclusions: These data suggested that neoadjuvant DXP chemotherapy could offer a reasonable chance for curative surgery in AGC patients with local invasion or paraaortic lymph node enlargement. No significant financial relationships to disclose.

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PCF chemotherapy combined with surgical treatment of advanced gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.113 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 113-113

Author(s):

Cheng Xiangdong

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Surgical Resection ◽

Distant Metastasis ◽

Metastatic Tumor ◽

Radical Resection ◽

R0 Resection ◽

Significant Difference ◽

Local Advanced ◽

Single Organ

113 Background: Local advanced gastric cancer that could not receive R0 resection or gastric cancer with distant metastasis usually received palliative chemotherapy or entered into a number of clinical trials, and surgery usually roled as a symptomatic treatment. This study is to investigate the efficacy and safety of PCF chemotherapy combined with surgery in the treatment of these patients. Methods: From July 2008 to February 2011, 72 cases of local advanced gastric cancer that cannot be treated with R0 resection (T4N2~3M0) or gastric cancer with single organ metastases (M1) were prospectively analysed. Patients received 2-4 cycles of PCF chemotherapy (PTX 150mg/m2, d1, CDDP 25mg/m2, d1-3, CF 250 mg/m2, d1-3,5-FU 750 mg/m2, d1-3, repeated every 3 weeks), then the primary and metastatic tumor were treated with cytoreductive surgery: mainly treated with radical resection of gastric tumor, combined with D3 and D4 lymph node dissection, pancreaticoduodenal resection, colon resection, ovariectomy, peritoneal resection, liver resection, and tumor radio frequency, followed with another 2-4 cycles of PCF chemotherapy. The treatment completion rate, patients’ tolerance, and overall survival (OS) time were analyzed. Results: 50 patients (69.4%) accomplished chemotherapy and surgical resection as planned. 42 cases had R0 resection (58.3%). The postoperative complication rate was 6.0%. Grade 3/4 toxic effects included bone marrow suppression (30.6%) and gastrointestinal reaction (40.3%), the overall response rate (CR+PR) was 72.2%. Survival analysis: the median survival time was 23.5 months. 1-year and 2-year survival rate was 67.0% and 47.0%. The OS of patients with surgical resection was much longer than that of the non-surgery group. (30.2 vs. 8.9 months) (p <0.01). The OS of local advanced group was 30.3 months, and was significantly longer than 17.6 months of the distant metastasis group (p <0.01); however, it had no significant difference compared to 28.2 months of the distant metastasis group with R0 resection. Conclusions: PCF chemotherapy combined with surgical resection were safe and effective, and can make survival benefits for patients with local advanced gastric cancer or gastric cancer with single organ metastasis.

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The real-world data in patients with advanced gastric cancer treated with ramucirumab combination chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.156 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 156-156

Author(s):

Akie Kimura ◽

Daisuke Sakai ◽

Toshihiro Kudo ◽

Naohiro Nishida ◽

Aya Katou ◽

...

Keyword(s):

Gastric Cancer ◽

Prognostic Factor ◽

Combination Therapy ◽

Advanced Gastric Cancer ◽

Response Rate ◽

Progression Free Survival ◽

Real World Data ◽

Neutrophil Lymphocyte Ratio ◽

Significant Difference ◽

Line Chemotherapy

156 Background: Ramucirumab with paclitaxel or ramucirumab monotherapy have shown the efficacy and safety in second-line chemotherapy for advanced gastric cancer. The previous reports have shown that neutrophil-lymphocyte ratio (NLR) was the prognostic factor for progression free survival. Methods: We conducted a retrospective review of clinical data from patients treated with ramucirumab at our institution between April 2015 to August 2018. Results: Of 90 patients, 81 received ramucirumab plus paclitaxel, and 9 received ramucirumab monotherapy. There was a significant difference of treatment line between combination therapy and monotherapy (mean 2.5 vs. 3.9, p = 0.00127). Response rate among the patients with target lesions was 18.8% (13/69), and disease control rate was 62.3% (43/69). On the other hand, response rate among the patients previously treated with nivolumab or pembrolizumab was 57.1% (4/7). Median overall survival (OS) for combination therapy and monotherapy was 10.8 months (95% confidence interval [CI] 7.1-11.9) and 5.5 months (95% CI 0.89-9.5), respectively. Grade 3 or 4 neutropenia was more common with combination therapy than with monotherapy (53.1 vs. 11.1%). Of 69 patients who received ramucirumab plus paclitaxel as second or third-line chemotherapy, high NLR (> 3) was the significant factor for poor PFS (median PFS, 2.7 vs. 5.4 months, p = 0.00103), but didn’t show the difference about OS (median OS, 9.7 vs. 11.9 months, p = 0.27). Conclusions: In our analysis, efficacy data was comparable with previous reports. In subgroup analysis, good response was observed in the group of prior nivolumab or pembrolizumab. NLR was prognostic factor for PFS, while it wasn’t show the relevance to OS because of the influence of after ramucirumab therapy.

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Short-term Outcomes of Robotic- versus Laparoscopic-Assisted Total Gastrectomy for Advanced Gastric Cancer: A Propensity Score Matching Study

10.21203/rs.2.16736/v1 ◽

2019 ◽

Author(s):

Changdong Yang ◽

Yan Shi ◽

Shaohui Xie ◽

Jun Chen ◽

Yongliang Zhao ◽

...

Keyword(s):

Gastric Cancer ◽

Propensity Score ◽

Advanced Gastric Cancer ◽

Propensity Score Matching ◽

Total Gastrectomy ◽

Resection Margin ◽

Operation Time ◽

Clinicopathological Characteristics ◽

Short Term ◽

Significant Difference

Abstract Background Few studies have been designed to evaluate the short-term outcomes for advanced gastric cancer (AGC) between robotic-assisted total gastrectomy (RATG) and laparoscopy-assisted total gastrectomy (LATG) alone. The purpose of this study was to assess short-term outcomes of RATG compared with LATG for AGC.Methods We retrospectively evaluated 116 and 244 patients who underwent RATG or LATG respectively. Besides, we performed a propensity score matching (PSM) analysis between RATG and LATG for clinicopathological characteristics to reduce bias and compared short-term surgical outcomes.Results After PSM, the RTAG group had longer mean operation time (291.09±58.41 vs. 271.99±48.41min, p=0.007), less intraoperative bleeding (151.98±92.83 vs. 172.59±97.01ml, p=0.032) and more N2 tier RLNs (9.33±5.46 vs. 7.50±3.86, p=0.018) than the LATG group. Besides, the total RLNs of RATG was at the brink of significance compared to LATG (35.09±12.93 vs.32.34±12.05, p=0.062). However, no significant differences were found between the two groups in terms of length of incision, proximal resection margin, distal resection margin, postoperative hospital stay. The conversion rate was 4.92% and 8.61% in the RATG and LATG groups, respectively, with no significant difference. The ratio of splenectomy was 1.7% and 0.4% respectively. There was no significant difference in overall complication rate between RATG and LATG groups before PSM (24.1% vs. 28.7%; p=0.341) and after PSM (24.1% vs. 33.6%; p=0.102). The grade II complications accounted for most of all complications in the two cohorts both before and after PSM.Conclusion This study demonstrates that RATG is comparable to LATG in terms of short-term surgical outcomes.

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