Impact of Minimally Invasive Surgery on Early and Late Outcomes of Patients With Gastric Cancer Treated Using Neoadjuvant Chemotherapy.

Autor: Araruna GF; Department of Abdominal Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil., Ribeiro HSC; Department of Abdominal Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil., Torres SM; Department of Abdominal Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil., Diniz AL; Department of Abdominal Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil., Godoy AL; Department of Abdominal Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil., Farias IC; Department of Abdominal Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil., Costa WL Jr; Department of Medicine, Epidemiology, and Population Sciences, Dan L Duncan Comprehensive, Cancer Center, Baylor College of Medicine, Houston, Texas, USA., Coimbra FJF; Department of Abdominal Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2024 Sep 19. Date of Electronic Publication: 2024 Sep 19.
DOI: 10.1002/jso.27904
Abstrakt: Background: Gastric cancer is the fifth most common neoplasm and the third leading cause of cancer-related death worldwide. Neoadjuvant chemotherapy is recommended for Stages II-III resectable tumors, but the comparative effectiveness of minimally invasive surgery (MIS) versus open gastrectomy (OG) post-neoadjuvant therapy has not been adequately investigated.
Methods: A retrospective cohort analysis was performed on patients with clinical Stage II and III gastric adenocarcinoma who underwent neoadjuvant chemotherapy followed by either MIS or OG between 2007 and 2020. Propensity score matching was utilized to compare the clinical and surgical outcomes, morbidity, and mortality, and the influence of MIS on 3-year survival rates was evaluated.
Results: After matching, no statistical differences in clinical aspects were noted between the two groups. MIS was associated with increased D2 lymphadenectomy, curative intent, and complete neoadjuvant therapy. Furthermore, this therapeutic approach resulted in reduced transfusion rates and shorter hospital stays. Nonetheless, no significant differences were observed in global, clinical, or surgical complications or mortality between the two groups. Weight loss emerged as a significant risk factor for complications, but MIS did not independently affect survival rates. Extended resection and higher American Society of Anesthesiology scores were independent predictors of reduced survival.
Conclusion: MIS after neoadjuvant chemotherapy for gastric cancer appears to be a viable option, with oncological outcomes comparable to those of OG, less blood loss, and shorter hospital stays. Although MIS did not independently affect long-term survival, it offered potential benefits in terms of postoperative recovery and morbidity. Further studies are needed to validate these findings, especially across diverse populations.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
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