新辅助化疗联合腹腔镜胃癌根治术治疗进展期胃上部癌疗效分析

Efficacy of neoadjuvant chemotherapy combined with laparoscopic radical gastrectomy in the treatment of upper advanced gastric cancer

目的:探讨进展期胃上部癌新辅助化疗(NAC)联合腹腔镜胃癌根治术的可行性。方法:回顾性分析2013年1月至2017年10月在郑州大学附属肿瘤医院接受NAC后行胃癌根治术并D2淋巴清扫的进展期胃上部癌患者193例的临床资料,行腹腔镜手术者76例,行开腹手术者117例;患者均采用SOX或XELOX方案进行NAC。使用倾向性评分匹配法(PSM)对两组进行1∶1匹配得到组间协变量均衡的样本,比较两组患者术中情况、术后恢复情况及预后。结果:PSM后,共138例纳入本研究,腹腔镜和开腹组各69例。腹腔镜组较开腹组手术时间长、术后胃肠功能恢复时间快(P<0.05)。腹腔镜组和开腹组3 a无复发生存率分别为68.6%、67.1%,3 a总生存率分别为75.8%和77.6%,两组生存曲线比较差异均无统计学意义(P>0.05)。结论:NAC联合腹腔镜胃癌根治术治疗进展期胃上部癌安全可行。

Aim:To investigate the feasibility of laparoscopic radical gastrectomy in patients with upper advanced gastric cancer after neoadjuvant chemotherapy(NAC).Methods:The clinical data of 193 patients with upper advanced gastric cancer who underwent radical resection of gastric cancer after NAC in the Affiliated Tumor Hospital,Zhengzhou University from January 2013 to October 2017 were analyzed retrospectively.Laparoscopic surgery was performed in 76 cases and laparotomy in 117 cases.The NAC regimen was SOX or XELOX,and propensity score matching(PSM)method was used to match the nearest 1∶1 of the 2 groups to get the samples with balanced covariates.The intraoperative condition,postoperative recovery and prognosis of the 2 groups were compared.Results:After PSM,a total of 138 patients were enrolled in this study,including laparoscopy group(n=69)and laparotomy group(n=69).The operation duration of laparoscopy group was longer than that of laparotomy group,and the recovery duration of gastrointestinal function after operation was faster in laparoscopy group than that in laparotomy group(P<0.05).The 3-year recurrence-free survival rate of laparoscopy group and laparotomy group was 68.6%and 67.1%,respectively,and the 3-year overall survival rate was 75.8%and 77.6%,respectively.The difference of survival curves between the 2 groups was not statistically different(P>0.05).Conclusion:NAC combined with laparoscopic radical gastrectomy for upper advanced gastric cancer is safe and feasible..