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效果及安全性

Efficacy and safety of neoadjuvant chemotherapy combined with laparoscopic-assisted radical gastrectomy for advanced gastric cancer

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疗效及安全性。方法回顾性纳入郑州人民医院2016年4月到2019年4月收治的行腹腔镜辅助胃癌根治术治疗的进展期胃癌患者76例。根据术前是否行新辅助化疗分为腹腔镜辅助胃癌根治术组(根治术组,35例)和新辅助化疗联合腹腔镜辅助胃癌根治术组(新辅助化疗组,41例)。对两组患者临床疗效、术后不良反应发生情况及随访1年后患者的死亡情况进行对比分析。结果新辅助化疗组所有患者均完成术前的新辅助化疗,两组患者均未出现治疗中断情况。新辅助化疗组有效率(85.4%,35/41)和疾病控制率(97.6%,40/41)均高于根治术组(25.7%,9/35;74.3%,26/35),P<0.05。新辅助化疗组根治性切除率为92.7%(38/41),姑息性切除率为7.3%(3/41);根治术组根治性切除率为74.3%(26/35),姑息性切除率为25.7%(9/35),两组根治性切除率和姑息性切除率比较差异有统计学意义(P<0.05)。两组患者术后并发症发生率、消化系毒性反应发生率、血液毒性反应发生率比较差异未见统计学意义(P>0.05)。随访1年,新辅助化疗组患者病死率(7.3%,3/41)低于根治术组(25.7%,9/35),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可提高患者的临床疗效和根治性切除率,降低患者的术后1年病死率,且并未增加术后并发症和化疗药物所致的毒性反应,安全性较好。

Objective To investigate the efficacy and safety of neoadjuvant chemotherapy combined with laparoscopic-assisted radical gastrectomy for advanced gastric cancer.Methods A total of 76 patients with advanced gastric cancer who underwent laparoscopic-assisted radical gastrectomy from April 2016 to April 2019 in Zhengzhou People’s Hospital were retrospectively included.According to whether had neoadjuvant chemotherapy before operation,patients were divided into laparoscopic-assisted radical gastrectomy group and neoadjuvant chemotherapy combined with laparoscopic-assisted radical gastrectomy group.The clinical efficacy,postoperative adverse reactions,and death of patients within 1 year follow-up were compared between the two groups.Results All patients in the neoadjuvant chemotherapy combined with laparoscopic-assisted radical gastrectomy group completed preoperative neoadjuvant chemotherapy,and there was no interruption of treatment between the two groups.The effective rate and disease control rate of neoadjuvant chemotherapy combined with laparoscopic-assisted radical gastrectomy group were 85.4%(35/41)and 97.6%(40/41),respectively,significantly higher than the 25.7%(9/35)and 74.3%(26/35)of laparoscopic-assisted radical gastrectomy group(P<0.05).The radical resection rate and palliative resection rate of neoadjuvant chemotherapy combined with laparoscopic-assisted radical gastrectomy group were 92.7%(38/41)and 7.3%(3/41),respectively;and the radical resection rate and palliative resection rate of laparoscopic-assisted radical gastrectomy group were 74.3%(26/35)and 25.7%(9/35).There were significant differences in radical resection rate and palliative resection rate between two groups(P<0.05).There was no significant difference in the incidence of postoperative complications,digestive system toxicity,or blood toxicity between the two groups(P>0.05).After 1-year follow up,the case fatality rate of neoadjuvant chemotherapy combined with laparoscopic-assisted radical gastrectomy group was 7.3%(3/41),significantly lower than the 25.7%(9/35)of laparoscopic-assisted radical gastrectomy group(P<0.05).Conclusions Neoadjuvant chemotherapy combined with laparoscopic-assisted radical gastrectomy for advanced gastric cancer can improve the clinical curative effect and radical resection rate,reduce the one-year postoperative case fatality rate,without increasing postoperative complications and toxic reactions caused by chemotherapy drugs,and has good safety.