新辅助化疗联合腹腔镜手术治疗进展期胃癌

Neoadjuvant Chemotherapy Combined with Laparoscopic Gastrectomy in Treatment of Local Advanced Gastric Cancer

目的评价新辅助化疗联合腹腔镜治疗进展期胃癌的临床疗效。方法2012年7月至2015年7月期间对我科24例局部进展期胃癌患者行2周期FLEEOX新辅助化疗，根据影像学观察病灶变化，化疗结束后2周内接受腹腔镜手术治疗。患者术后接受XELOX化疗方案6个疗程。结果①化疗有效率：病灶完全缓解者4例（16．6％），部分缓解者18例（75．0％），疾病稳定者1例（4．2％），疾病进展者1例（4．2％），临床总有效率为91．6％（22／24）。②化疗前后血液肿瘤标志物变化：CEA、CA19—9及CA125指标在化疗后均明显低于化疗前水平（P〈0．001）且在正常参考范围内。③手术情况：24例患者均完成2个疗程新辅助化疗后接受了腹腔镜探查手术。有2例患者因腹腔内广泛转移仅行姑息性胃空肠吻合术，其余22例患者接受腹腔镜下D2手术。手术时间（236±45）min，术中出血量（150±50）mL，淋巴结清扫数目（17．4±5．3）枚，胃肠道功能恢复时间（3．1±0．8）d。④术后并发症：无因手术死亡者，发生吻合口漏1例，肠梗阻1例，肺部感染1例，所有患者术后并发症经保守治疗后治愈。⑤毒副反应：9例患者血红蛋白下降，14例患者白细胞降低，8例血小板降低，5例患者ALT升高，6例患者AST升高。19例患者出现恶心症状。10例患者出现手足麻木等神经毒副反应，经治疗后缓解。⑥随访结果：截止到2015年11月，随访4～39个月，1例患者腹腔广泛转移而死于恶病质，1例患者出现肝脏多发转移而死于肝功能衰竭，1例患者出现脑转移而死亡，1例患者因其他疾病死亡，剩余20例患者仍存活。随访中无切口及戳孔种植性转移发生。结论从本组有限的数据初步得出，FLEEOX新辅助化疗方案联合腹腔镜治疗局部进展期胃癌安全、有效，具有创伤小、术后恢复快的特点。

Objective To evaluate clinical effect of neoadjuvant chemotherapy combined with laparoscopic gastre- ctomy in treatment of local advanced gastric cancer. Methods The clinical data of 24 patients with local advanced gastric cancer undergoing 2 courses of FLEEOX neoadjuvant chemotherapy from July 2012 to July 2015 were analyzed. The efficacy of neoadjuvant chemotherapy based on radiographic results was evaluated. The gastrectomy was performed on week 2 after neoadjuvant chemotherapy. Patients were treated with XELOX regimen as adjuvant chemotherapy after laparoscopic gastrectomy. Results （1） Complete response occurred in 4 cases （16.6%）, partial response in 18 cases （75.0%）, stable disease in 1 case （4.2%）, disease progressive in 1 case （4.2%）. The total effective rate of neoadjuvant chemotherapy was 91.6% （22/24）. （2） The serum tumor markers CEA, CA19-9, and CA125 levels after neoadjuvant chemotherapy were significantly lower than those before neoadjuvant chemotherapy （P〈0.001） and reached normal levels. （3） Two courses of neoadjuvant chemotherapy and laparoscopic exploration were completed successfully in these 24 patients. Two patients with intraabdominal metastasis were underwent palliative gastrojejunostomy, the other 22 patients were underwent laparo- scopic D2 radical gastrectomy. The operative time was （236±45） min, the intraoperative blood loss was （150±50） mL, thenumber of lymph node dissected was 17.4 ± 5.3, the postoperative gastrointestinal function recovery time was （3.1±0.8） d. （4） There was no death due to surgery. One case suffered anastomotic leakage, 1 case intestinal obstruction, and 1 case pulmonary infection after surgery. The postoperative complications were cured by conservative treatment. （5） The haema- tological adverse events included anemia （9 patients）, leukopenia （14 patients）, thrombocytopenia （8 patients）, aminotran- sferase abnormality （5 in elevated ALT, 6 in elevated AST）, the most common toxicity was nausea （19 patients）, 10 patients suffered nerve toxicity. All the patients were relieved after treatment. （6） The patients were followed up for 4-39 months, 1 case died of cachexia as the result of extensive abdominal metastasis, 1 case died of liver failure as the result of multiple liver metastases, 1 case was death as the result of brain metastasis, 1 case was death as the result of the other cause, the other 20 patients were alive. Conclusions The preliminary results of limited cases in this study show that FLEEOX neoadjuvant chemotherapy combined with laparoscopic gastrectomy for local advanced gastric cancer is safe and effective. It has advantages of minimal invasion and fast recovery.