新辅助化疗联合腹腔镜手术治疗进展期胃癌效果及患者生活质量情况观察

Neoadjuvant chemotherapy combined with laparoscopic surgery for treatment of advanced gastric cancer: Efficacy and impact on quality of life

目的探讨新辅助化疗联合腹腔镜辅助胃癌根治术治疗进展期胃癌的临床效果及对患者生活质量的影响.方法回顾性分析我院在2014-02/2016-11收治的进展期胃癌患者104例,根据患者意愿决定是否术前行新辅助化疗,分为观察组(新辅助化疗+腹腔镜手术组)56例,对照组(直接行腹腔镜辅助胃癌根治术组)48例,术后均给予6个疗程XELOX化疗;观察两组患者临床疗效、手术指标、术后恢复情况、生活质量、化疗期间不良反应发生率及复发、转移率.结果新辅助化疗后腹腔镜术前观察组临床有效率48.21%,疾病控制率为92.45%.两组患者手术时间、术中出血量、中转开腹例数、手术切除范围、姑息性手术例数及淋巴结清扫数比较差异无统计学意义(P>0.05);观察组手术切缘R0切除率明显高于对照组(85.71%vs 52.08%),差异具有统计学意义(P<0.05);两组患者术后下床活动时间、肛门排气时间、术后并发症发生率及住院时间比较差异无统计学意义(P>0.05).观察组在化疗结束后3 mo、6 mo KPS评分(82.8±6.9 vs 91.6±8.1)明显高于对照组(76.2±5.1 vs 85.2±7.3),差异具有统计学意义(P<0.05).治疗期间观察组出现3级以上不良反应发生率为16.07%,对照组为16.67%,差异无统计学意义(P>0.05).截止至2017-12,随访9-46 mo,中位随访时间为24 mo,随访期间观察组共出现4例死亡,10例复发、转移,对照组出现11例死亡,19例复发转移,比较差异具有统计学意义(χ~2=5.210,6.067,P<0.05).Log-rank检验分析显示,观察组死亡风险明显低于对照组,差异具有统计学意义(P<0.05).结论新辅助化疗联合腹腔镜辅助胃癌根治术治疗进展期胃癌疗效显著,能够显著提高手术切缘R0切除率,改善患者生活质量,减少复发转移,提高患者生存期.

AIM To investigate the clinical effect of neoadjuvantchemotherapy combined with laparoscopic-assisted radical gastrectomy in treating advanced gastric cancer and the effect on the quality of life of patients.A retrospective analysis was performed of 104 cases of advanced gastric cancer admitted from February 2014 to November 2016 at Taizhou Hospital. According to whether the patients would like to undergo neoadjuvant chemotherapy or not, they were divided into an observation group （neoadjuvant chemotherapy plus laparoscopic surgery; n = 56） or a control group （direct laparoscopic-assisted radical gastrectomy; n = 48）. Both groups were given six courses of XELOX chemotherapy after operation. Clinical efficacy, operation indexes, postoperative recovery, quality of life, adverse reactions, and recurrence or metastasis were compared between the two groups. After neoadjuvant chemotherapy, the effective rate and disease control rate in the observation group were 48.21% and 92.45%, respectively. There was no significant difference in operative time, intraoperative blood loss, number of cases of conversion to open laparotomy, surgical excision range, number of cases of palliative surgery, or number of lymph nodes dissected between the two groups （P 〉 0.05）. The R0 resection rate in the observation group was significantly higher than that of the control group （85.71% vs 52.08%, P 〈 0.05）. There was no significant difference in time to ambulation, time to anal exhaust, postoperative complications, or hospital stay between the two groups （P 〉 0.05）. The KPS scores of the observation group at 3 and 6 months after chemotherapy were significantly higher than those of the control group （82.8 ± 6.9 vs 76.2 ± 5.1, 91.6 ± 8.1 vs 85.2± 7.3, P 〈 0.05）. As of December 2017, the follow-up period ranged from 9 to 46 mo, and the median follow-up time was 24 mo. During the follow-up period, four patients died and ten patients developed recurrence or metastasis in the observation group. In the control group, 11 patients died and 19 developed recurrence or metastasis. There was a significant difference in the rates of death and recurrence/metastasis between the two groups （χ2 = 5.210, 6.067, P 〈 0.05）. Log-rank test analysis showed that the risk of death in the observation group was significantly lower than that of the control group （P 〈 0.05）. CONCLUSION Neoadjuvant chemotherapy combined with laparoscopic radical gastrectomy for advanced gastric cancer has significant curative effects and can significantly improve the resection rate and quality of life, reduce recurrence and metastasis, and improve the survival of patients.