Safety And Feasibility Of Laparoscopic Gastrectomy For Patients With Locally Advanced Gastric Cancer Following Neoadjuvant Chemotherapy

Aims:To assess the safety and feasibility of laparoscopic gastrectomy(LG)for patients with locallyadvancedgastriccancerfollowingneoadjuvantchemotherapy(NACT).Materials and methods:We performed a retrospective study of patients with LAGC who received either LG following NACT or upfront LG between March 2013 and October 2018.Thestudy comprised 76 cases,including 41(53.9%)in the NACT-LG group and 35(46.1%)in the LG group.The Pearson Chi-square test,Fisher’s exact test and Mann-Whitney rank-sum test were used to evaluate differences in surgical procedures,postoperativerecovery,surgical morbidity andmortality,and pathological outcomes between the two groups.The Clavien-Dindo classification system was used to determine the severity of postoperative complications,andtumor regression gradewas used to evaluate the efficacy of chemotherapy.A Kaplan Meier survival analysis was performed using a log-rank test to estimate differences in thedisease-freesurvival and overallsurvival.Results: All patientswith LAGC underwent an LG with D2 lymphadenectomy.The surgical trauma index in terms of incision length and blood loss,and postoperative recovery index in terms of first aerofluxus time,first time on liquid diets,pull drainage time,and hospital stays did not significantly differ between the two groups(all P>0.05).Patients in the NACT-LG grouphad a longer operation time(286.5 vs 248.9 minutes,P<0.05)but higher R0 resection rate(95.1% vs 77.1%,P<0.05).The incidence of postoperative complications in the two groups was 19.5%and 22.9%(P =0.721),and the mortality was 0% and 2.9%(P=0.461)with no statistically significantdifferences,respectively.Subgroup analysis showed that there was no significant difference in the incidence of GradeⅠ-Ⅴcomplications.Inthe NACT-LG group,the pathological response to NACT was65.9%,andover half(21/41,51.2%)of the patients obtained tumor downstaging.Four patients(9.8%)wereconsidered pathologicalcomplete responders after NACT.The3-year disease-free and overall survival were 59.4% and 69.0% in the NACT-LG group and 14.4% and 37.4% in the LG group,respectively,with statistically significantdifferences(all P<0.05).Conclusions:LGfollowing NACTfor patients with LAGC is not inferior to upfront LG in terms of surgical trauma,postoperative recovery,surgical morbidity andmortality,and has the advantages of tumor downstaging,higher R0 resection rate,and bettersurvival.