Safety Analysis Of Neoadjuvant Chemotherapy In Operation For Advanced Gastric Cancer

Objective:To compare the effect of preoperative neoadjuvant chemotherapy on short-term postoperative complications in patients with advanced gastric cancer..Methods:This study retrospectively analyzed patients with resectable advanced gas-tric cancer who received radical gastrectomy in our hospital from January 2015 to De-cember 2020.Patients undergoing direct surgery were selected as the control group,and confounding was controlled by propensity score matching and multiple regression mod-el.After matching,the surgical safety of the two groups was compared.The main ob-servation was the incidence of postoperative complications in the two groups,including clavien-Dindo classification and classification of postoperative complications.Second-ary observation results were operation time,intraoperative blood loss,postoperative drainage tube removal time,exhaust time,feeding time,defecation time,postoperative hospital stay and total cost,etc.In the multi-factor analysis,three different models were constructed,and model I did not include any covariable.Model II included:p N.Model III includes all covariables,that is,full adjustment.A stratified binary logistic regression model was also used to conduct a subgroup analysis of the relationship between pre-operative neoadjuvant chemotherapy and recent postoperative complications.Result:A total of 222 patients were enrolled in this study,including 159 patients in the direct surgery group and 63 patients in the neoadjuvant chemotherapy group.After propensity score matching,60 patients in the neoadjuvant chemotherapy group and 60in the direct surgery group were included in the final data analysis.The incidence of near-term postoperative complications was significantly lower in the neoadjuvant chemotherapy group than in the direct surgery group（13.33%vs.36.67%,P=0.003）,and the incidence of grade III-IV near-term postoperative complications was significant-ly lower in the neoadjuvant chemotherapy group（1.67%vs.11.67%,P=0.028）.In uni-variate analysis,T_4a patients in p T stage compared with T₃ patients and IIIC patients in clinicopathological stage compared with IIA patients had an increased risk of postopera-tive complications（OR=1.38,95%CI 1.19-3.24,P=0.041 and OR=1.61,95%CI 1.14-2.64,P=0.035,respectively）.In the multivariate analysis,the OR（95%CI）of preopera-tive neoadjuvant chemotherapy and postoperative near-term complications were 0.27（0.11,0.66,P=0.004）,0.25（0.10,0.65,P=0.004）and 0.18（0.06,0.60,P=0.005）,after the inclusion of no covariable,p N and all covariables,respectively.Among the second-ary observations,compared with the direct surgery group,the length of postoperative hospital stay[（11.15±3.51）d vs.（13.78±6.57）d,P=0.007],exhaust time[（3.12±0.76）d vs.（3.60±0.74）d,P<0.001],feeding time[（5.13±1.58）d vs.（6.10±2.22）d,P=0.007],defecation time[（5.18±1.40）d vs.（6.80±2.75）d,P<0.001],the removal time of drainage tube[（7.48±1.67）d vs.（9.63±5.98）d,P=0.008]was significantly shorter,the intraoperative blood loss[（199.67±134.44）ml vs.（335.50±291.61）ml,P=0.001]and the total cost[（81 449.00±18471.07）yuan vs.（100 207.68±29 682.41）yuan,P<0.001]significantly decreased,and the difference was statistically significant.Conclusion:Compared with the direct surgery group,neoadjuvant chemotherapy sig-nificantly reduced the incidence of postoperative near-term complications of advanced gastric cancer,and significantly reduced the risk of postoperative near-term complica-tions of grade III-IV.Moreover,it has the advantages of short term efficacy,such as less intraoperative blood loss,fast postoperative recovery,low hospitalization cost,fast feed-ing and defecation time.The effect of neoadjuvant chemotherapy on the surgical safety of advanced gastric cancer needs to be further confirmed by more studies.