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Impact of Neoadjuvant Therapy on Minimally Invasive Surgical Outcomes in Advanced Gastric Cancer: An International Propensity Score-Matched Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

No international consensus on the treatment of advanced gastric cancer (AGC) exists. In the absence of well-designed, comparative studies between neoadjuvant versus adjuvant strategies, concerns about increased risk of postoperative complications remain barriers to neoadjuvant chemotherapy (NAC) for AGC. We evaluated surgical outcomes of AGC patients who received minimally invasive radical gastrectomy with D2 lymphadenectomy after NAC.

Methods

We collected data from two high-volume gastric cancer programs in the United States and China between January 2015 and December 2019 with the last follow-up in February 2020. AGC patients undergoing minimally invasive radical surgery were included. After propensity score-matching, surgical outcomes were analyzed. Risk-factor of complications was analyzed in the whole cohort.

Results

After 1:1 propensity score-matching, 97 patients were included in each cohort. NAC + surgery cohort was younger (58.2 ± 10.3 vs. 61.3 ± 9.6, P = 0.036) with lower preoperative WBC count (5.7 ± 2.8 vs. 6.9 ± 2.1 × 109/ml) than the surgery upfront cohort. NAC was not a risk-factor for postoperative complications (odds ratio [OR], 0.859; 95% confidence interval [CI], 0.46–1.60; P = 0.633). Overall risk-factors of postoperative complications included age ≥ 60 years (OR, 21.338; 95% CI, 5.00–91.05; P < 0.001), tumor size ≥ 5 cm (OR, 1.24; 95% CI, 1.08–1.83; P < 0.001), operation time ≥ 240 min (OR, 5.53; 95% CI, 1.26–24.26; P = 0.012), and ASA classification ≥ II (OR, 13.14; 95% CI, 4.12–24.73; P < 0.001).

Conclusions

NAC before minimally invasive radical gastrectomy with D2 lymphadenectomy does not increase postoperative complications, and these findings support broader application of NAC and MIS for AGC. Additional studies are required to determine the effect of NAC on long-term survival.

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Acknowledgment

The authors thank Supriya Deshpande, Ph.D., for editorial assistance.

Funding

This work was supported by the Department of Defense, Idea Award [CA180425 to Y.W.].

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, City of Hope National Comprehensive Cancer Center, Duarte, CA, USA

    Yongjia Yan MD PhD, Annie Yang MD, Yuman Fong MD & Yanghee Woo MD

  2. Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China

    Yongjia Yan MD PhD, Li Lu MD, Zhicheng Zhao MD, Chuan Li MD, Weidong Li MD, Tong Liu MD & Weihua Fu MD, PhD

  3. Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA, USA

    Joseph Chao MD

  4. Cancer Immunotherapeutics Program, Beckman Research Institute, City of Hope, Duarte, CA, USA

    Yanghee Woo MD

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Correspondence to Weihua Fu MD, PhD or Yanghee Woo MD.

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Yan, Y., Yang, A., Lu, L. et al. Impact of Neoadjuvant Therapy on Minimally Invasive Surgical Outcomes in Advanced Gastric Cancer: An International Propensity Score-Matched Study. Ann Surg Oncol 28, 1428–1436 (2021). https://doi.org/10.1245/s10434-020-09070-9

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