Clinical Study Of Neoadjuvant Chemotherapy Combined With Surgery For Locally Advanced Gastric Cancer Based On Membrane Anatomy

Objective:We retrospectively collected clinical information of locally advanced gastric cancer(LAGC)patients who received neoadjuvant chemotherapy(NAC)in the Cancer Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College.The purpose of the study is to explore the safety and effectiveness of neoadjuvant chemotherapy combined with surgical treatment for gastric cancer based on membrane anatomy.Material and methods:We retrospectively analyzed the clinical data of LAGC patients who underwent radical resection after receiving neoadjuvant chemotherapy at the Cancer Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College from January 2008 to December 2018.According to the Mandard standard,the pathological tumor regression grade(Tumor Regression Grade,TRG)after neoadjuvant treatment of tumor was performed.Firstly,we performed survival analysis according to the Mandard classification,and divided the TRG classification into the pathologically effective group and the pathologically ineffective group based on the results of the survival analysis.The factors affecting the pathological efficacy of neoadjuvant chemotherapy in LAGC patients were analyzed by Logistic single factor and multiple factors.Then,according to the surgical method,we compared the differences in the surgical indicators,postoperative recovery indicators,and survival among the 3D laparoscopic surgery group(3D group),the 2D laparoscopic surgery group(2D group)and the open surgery group(open group).Results:For 244 LAGC patients receiving NAC,survival analysis combined with TRG classification can be used to define TRG1-3 as pathologically effective and TRG4-5 as pathologically ineffective.Further analysis showed gender(female VS male,OR:1.882,95%CI:1.058-3.3350,P=0.032),tumor size(<2cm VS 2cm-5cm,OR:0.087,95%CI:0.011-0.685,P=0.020;<2cm VS>5cm,OR:0.091,95%CI:0.011-0.747,P=0.026)were independent factors influencing the pathological efficacy of neoadjuvant chemotherapy.196 patients were further screened,including 32 in the 3D group,38 in the 2D group,and 126 in the open group.The postoperative gastric tube indwelling time was shorter in the 3D group than in the open group(P=0.009).There was no significant difference between the 3D group and the open group and the 2D group in terms of the number of lymph node dissections,intraoperative blood loss,blood transfusion,operation time,hospital stay,ICU treatment ratio,postoperative complications,etc.(P>0.05).In addition,the 3D group had longer survival time without disease progression than the open group(P=0.033),but there was no significant difference in overall survival time.Conclusion:In this study,the pathological efficacy after neoadjuvant chemotherapy in LAGC patients was defined by combining TRG classification and survival analysis.At the same time,independent influencing factors affecting pathological efficacy were discovered.Further analysis shows that 3D laparoscopic surgery based on membrane anatomy is safe and feasible in LAGC patients after neoadjuvant treatment,but more cases and prospective trials are needed to verify.