Meta-analysis Of The Efficacy And Safety Of Neoadjuvant Chemotherapy Followed By Radical Gastrectomy For Esophagogastric Junction Adenocarcinoma

Objective:To systematically evaluate the efficacy and safety of radical gastrectomy combined with neoadjuvant chemotherapy in the treatment of esophageal and gastric junction adenocarcinoma.Methods:Computer search databases such as Web of Science,Wan Fang Data,Pub Med,Embase,The Cochrane Library,CBM,CNKI and collection of publicly published randomized controlled trials(RCTs),prospective cohort studies and retrospective case control studies,on radical gastrectomy combined with neoadjuvant chemotherapy for AEG at home and abroad.The search time limit was from the establishment of the database until January 2023.A total of 2 researchers conducted independently literature screening,data extraction and bias risk assessment of literature research,and then used Rev Man 5.3 software to do Meta-analysis.Results:A total of 1208 relevant documents were obtained in the initial examination.After the screening step by step,eight related literatures were finally included,a total of 638 Siewert type II and III AEG patients,including 344 AEG patients in the test group and 294 AEG patients in the control group.The final result of the Meta-analysis was that compared to simple radical gastrectomy for gastric cancer,the combined neoadjuvant chemotherapy group has a high R0 resection rate[OR=5.16,95%CI(2.94～9.08),P<0.00001],a smaller maximum diameter of the tumor after surgery[MD=-0.61,95%CI(-0.93～-0.29),P=0.0002],a lower incidence of nerve infiltration[OR=0.24,95%CI(0.14～0.41),P<0.00001],a lower incidence of vascular cancer thrombi[OR=0.18,95%CI(0.08～0.38),P<0.0001],and fewer lymph node dissection[MD=-1.43,95%CI(-2.55～-0.30),P=0.01].Among the indicators related to surgical treatment,the surgical time was shorter[MD=-12.54,95%CI(-21.04～-4.03),P=0.004],and there was no statistically significant difference in hospital stay[MD=-0.72,95%CI(-1.72～0.29),P=0.16],intraoperative bleeding[MD=-9.64,95%CI(-22.26～2.97),P=0.13],and postoperative complication incidence[OR=0.72,95%CI(0.48～1.08),P=0.11].There was no statistically significant difference in postoperative 1-year survival rate[OR=1.26,95%CI(0.66～2.39),P=0.49] and 3-year survival rate[OR=1.91,95%CI(0.42～8.70),P=0.40].Conclusion:The treatment method of radical gastrectomy after neoadjuvant chemotherapy is safe and effective for patient safety with Siewert II and III AEG,which can improve the radical resection rate(R0),reduce the tumor size,and reduce the risk of metastasis,without increasing the difficulty of surgery and the incidence of postoperative complications.Further validation is needed to determine whether patients benefit from survival.