Assessment of Laparoscopic Distal Gastrectomy After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

Li, Ziyu; Shan, Fei; Ying, Xiangji; Zhang, Yan; Jian‐Yu, E; Wang, Yinkui; Ren, Hui; Su, Xiangqian; Ji, Jiafu

doi:10.1001/jamasurg.2019.3473

Cited by 143 publications

(174 citation statements)

References 25 publications

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“…LG was associated with a lower postoperative pain score (visual analog scale) compared with OG (1.5 vs 3; P = 0.04) 48 . Wu et al compared 2 groups of GC patients.…”

Section: Discussionmentioning

confidence: 90%

Oncological Outcomes of Laparoscopic Versus Open Gastrectomy After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: A Retrospective Multicenter Study

Khaled

Soliman

Faisal

et al. 2020

Preprint

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Background: Oncological outcomes of laparoscopic gastrectomy (LG) and open gastrectomy (OG) following neo-adjuvant chemotherapy were investigated in few studies. Our purpose was to evaluate the oncological outcomes of LG and OG after neoadjuvant chemotherapy for patients with locally advanced GC to determine its safety and feasibility.Methods: We conducted a retrospective chart review for all patients who underwent either OG (n = 43) or LG (n = 41). The neoadjuvant treatment regimen consisted of capecitabine plus oxaliplatin for 3 cycles, which was then repeated for 5 cycles 6 to 12 weeks after the operation.Results: The hospital stay length and intraoperative blood loss the LG group were significantly lower than in the OG group. The in-hospital mortality rate and the 3-year survival rate for patients in the OG group were comparable to that of patients in the LG group (4.6% vs 9.7%; 58.1% vs 68.3%, respectively). Similar trends were observed regarding the 3-year recurrence rate and metastasis. The mean survival time was 52.9 months (95% confidence interval [CI], 44.2–61.6) in the OG group compared with 43.3 (95% CI, 36.6–49.8) in the LG group. Likewise, the mean disease-free survival was 56.1 months (95% CI, 46.36–65.8) in the LG group compared with 50.9 months (95% CI, 44.6–57.2) in the OG group.Conclusion: Compared to OG, LG is a feasible and safe alternative for patients receiving neoadjuvant chemotherapy with locally advanced GC.

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“…LG was associated with a lower postoperative pain score (visual analog scale) compared with OG (1.5 vs 3; P = 0.04) 48 . Wu et al compared 2 groups of GC patients.…”

Section: Discussionmentioning

confidence: 90%

Oncological Outcomes of Laparoscopic Versus Open Gastrectomy After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: A Retrospective Multicenter Study

Khaled

Soliman

Faisal

et al. 2020

Preprint

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“…It was reported that the negative effects of chemotherapy on operation might be overcome by laparoscope. Laparoscopic surgery offers amplifying visual, better exposure of anatomical hierarchy, and then contributes to delicate anatomy of blood vessels and lymphatic vessels [19]. On the other hand, adverse effects caused by chemotherapy can be attenuated by optimized perioperative care.…”

Section: Discussionmentioning

confidence: 99%

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

Liu

Lin

et al. 2020

Preprint

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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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“…Unfortunately, very few studies report the number of patients which received neoadjuvant treatment. In a small-scale RCT analyzing the impact of neoadjuvant chemotherapy for AGC in the surgical outcome, Li et al showed that the group of patients treated laparoscopically did benefit of the lower risk of postoperative complications and were able to better tolerate the planned adjuvant chemotherapy [27]. Nevertheless, evidence on the role of minimally invasive surgery in patients treated with neoadjuvant chemotherapy is still lacking and further investigation comparing laparoscopic and open gastrectomy in the era of perioperative therapies is warranted.…”

Section: Discussionmentioning

confidence: 99%

Implementation of minimally invasive gastrectomy for gastric cancer in a western tertiary referral center

et al. 2020

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Background: Minimally invasive techniques have gradually come to take a leading position in the surgical treatment of gastrointestinal malignancies. In order to define an effective process for the implementation of similar techniques in the treatment of gastric cancer, patient caseload represents a pivotal factor for education and training, but is a prerequisite not fulfilled in most Western countries. Additionally, as opposed to the East, a variety of additional factors such as the usually advanced stage of the disease and differences in patient characteristics are prevailing and raise further obstacles. Hereby we report a strategy for a safe and effective process for the implementation of laparoscopic gastric cancer surgery in a Western tertiary referral center. Methods: The present study describes the stepwise implementation of laparoscopic gastrectomy for the treatment of gastric cancer at a tertiary referral center, comprising the time period 2012-2019. This process was facilitated by a close collaboration with two high-volume centers in Japan, as well as exchanging fellowships and observerships between the Karolinska University Hospital and other European centers. From the initially strict selection of cases for laparoscopic surgery, laparoscopic gastrectomy has gradually become the preferred approach also in patients with locally advanced tumors. Results: From January 1st 2010 until December 31st 2019, 249 patients were operated for gastric cancer, of whom 141 (56.6%) had an open and 108 (43.4%) a laparoscopic procedure. In the latter group, total gastrectomy was performed in 33.3% of the patients. While blood loss, operation time and length of stay decreased during the first years after implementation, these variables increased slightly during the last years of the study period, probably due to the higher proportion of advanced gastric cancer cases, as well as the higher rate of laparoscopic total gastrectomy with more extended lymphadenectomy. Conclusions: Laparoscopic surgery is currently a valid therapeutic option for gastric cancer, which has expanded to also embrace total gastrectomy and locally advanced tumors. Collaboration between centers in the East and West, centralization to high-volume centers and application of enhanced recovery protocols are essential components in the implementation and further refinement of minimally invasive gastrectomy.

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Assessment of Laparoscopic Distal Gastrectomy After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer

Cited by 143 publications

References 25 publications

Oncological Outcomes of Laparoscopic Versus Open Gastrectomy After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: A Retrospective Multicenter Study

Oncological Outcomes of Laparoscopic Versus Open Gastrectomy After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: A Retrospective Multicenter Study

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

Implementation of minimally invasive gastrectomy for gastric cancer in a western tertiary referral center

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