Laparoscopic gastrectomy for gastric carcinoma with neoadjuvant chemotherapy

Abstract

Objectives: Neoadjuvant chemotherapy is a widely-accepted potential treatment for locally-advanced gastric carcinoma. Laparoscopic gastrectomy is performed for advanced gastric carcinoma because it is minimally invasive, which could lead to accessibility to combined chemotherapies. We evaluated the feasibility of performing laparoscopic gastrectomy in patients with or without neoadjuvant chemotherapy. Methods: We performed a retrospective cohort study that was conducted from 2005–2013. We assessed 49 and 35 patients with clinical stage III disease who underwent laparoscopic gastrectomy with and without neoadjuvant chemotherapy, respectively, using a two-cycle regimen of S-1 plus cisplatin. We evaluated patients’ background data, efficacy and adverse events of chemotherapy, and perioperative factors, including the postoperative complication rate, reoperation rate, and length of hospital stay. Results: Adverse events of grade 3 or higher during neoadjuvant chemotherapy were observed in five (10.2%) patients. The response and disease control rates were 61.2% and 93.9%, respectively. There were no significant differences in the postoperative complication rate, reoperation rate, and length of hospital stay between the groups. There were no conversions to laparotomy and no in-hospital deaths. Multivariate analyses showed that total gastrectomy was the only significant independent risk factor for determining postoperative complications, and neoadjuvant chemotherapy was not a risk factor. Conclusions: Our protocol of laparoscopic gastrectomy for locally-advanced gastric carcinoma following neoadjuvant chemotherapy resulted in a considerable response to the chemotherapy and sufficient feasibility in the selected patients. Our strategy is a promising therapeutic option for patients with locally-advanced gastric carcinoma.

Keywords

• gastric cancer
• gastrectomy
• laparoscope
• drug therapy
• morbidity