Total Neoadjuvant Chemotherapy Followed by Laparoscopic Radical Gastrectomy Versus Neoadjuvant Chemotherapy for Clinical Stage T4a-bN + M0 Proximal Gastric Cancer: A Single-Center Retrospective Data Analysis.

Abstract

Background: While preoperative neoadjuvant chemotherapy (NT) followed by surgery has gained acceptance in the management of locally advanced gastric cancer (LAGC), there remains a paucity of studies examining the efficacy of total neoadjuvant chemotherapy (TNT) for LAGC. This study was aimed at addressing this gap by comparing the outcomes of patients with clinical stage T4a-bN + M0 proximal gastric cancer treated with TNT and NT. The investigation sought to provide valuable insights into the effectiveness of the TNT regimen in this specific clinical context.

Methods: Retrospective analysis was conducted on the clinical data of patients diagnosed with proximal LAGC who underwent perioperative docetaxel, oxaliplatin, and fluorouracil (FLOT) chemotherapy followed by laparoscopic radical gastrectomy at Longyan First Hospital affiliated with Fujian Medical University. The study, spanning from January 2017 to December 2019, included 26 patients in the TNT group and 32 patients in the NT group. Comparative assessments were made regarding the outcomes of chemotherapy and surgery, as well as the 3-year disease-free survival (DFS) and overall survival (OS) between the two groups.

Results: The TNT group demonstrated superiority over the NT group in terms of operation time and intraoperative blood loss. While no significant difference was observed in total postoperative complications between the two groups, the TNT group exhibited a more pronounced downstaging in T stage and a higher rate of pathological complete regression. The 3-year OS rate was notably higher in the TNT group at 61.5%, compared to 46.9% in the NT group. Similarly, the 3-year DFS rate favored the TNT group at 53.8%, surpassing the rate of 34.4% in the NT group.

Conclusions: The TNT approach for LAGC had the potential to enhance tumor regression and increase the completion rate of chemotherapy. This strategy demonstrated a positive trend in long-term outcomes and introduced a novel treatment model.