The Evidence-based Study Of Surgical Treatment Strategy In Gastric Cancer

Background and aims:Gastric cancer is the fourth most common cancer and the second leading cause of cancer death in the world. Nowadays, surgical treatment strategy in gastric cancer remains a protracted and controversial topic, such as the extent of lymphadenectomy for gastric cancer, the effectiveness and safety of laparoscopy-assisted gastrectomy (LAG) versus open gastrectomy for resectable gastric cancer, the magnitude of survival benefits of neoadjuvant chemotherapy (NAT) in resectable gastric cancer. We solve these questions using meta-analysis methods. We investigated the efficacy and safety of capecitabine and oxalip latin (XELOX) with oxalip latin, folinic acid and tegafur (modified FOLFOX) for gastric cancer after D2gastrectomy.Methods:We searched electronic database to identify related randomized controlled trials (RCTs) from their inception to April2012. Meta-analyses were performed using RevMan5.1software. It was in line with the Preferred Reporting Items for Systematic reviews and Meta-analyses statement. The quality of evidence was assessed by GRADE pro3.6. We evaluated the efficacy and toxicity of two regimens according to world health organization criterion. Statistical analyses were performed with SPSS software version19.0.Results:Meta-analysis indicated that:(1) compared Dl lymphadenectomy, D2lymphadenectomy is associated with significantly higher postoperative risk, a trend of lower gastric cancer-related death exists among D2patients who did not undergo resection of the spleen or pancreas. D3lymphadenectomy does not improve the survival rate in curable gastric cancer as compared with D2lymphadenectomy alone;(2)LAG was still a time-consuming and technically dependent procedure, it has the advantage of better short-term outcome, long term survival data from other studies are urgently needed to estimate the survival benefit of this technique;(3)a survival benefit of neoadjuvant chemotherapy over surgery alone in patient with cancer of the gastric and gastroesophageal junction, without increase postoperative complications rate. XELOX regimen and modified FOLFOX regimen have similar short-terms efficacy, the incidence of gastrointestinal toxicity, alopecia and hand-foot syndrome of modified FOLFOX regimen was higher than XELOX regimen, but a higher incidence of hand-foot syndrome in the XELOX group.Conclusions:Current clinical evidence indicated that D2lymphadenectomy should be recommended as the standard surgical approach to resectable gastric cancer; LAG is a safe and feasible procedure in the treatment of resectable gastric cancer, a long-term oncological outcome has not been established; neoadjuvant chemotherapy could improve the overall survival for patient with cancer of the gastric and gastroesophageal junction; XELOX regimen and modified FOLFOX regimen have similar short-terms efficacy, the total incidence of side effects of modified FOLFOX regimen was higher than XELOX regimen.