Abstract: Objective:To explore the clinical efficacy of neoadjuvant chemotherapy combined with laparoscopyassisted radical gastrectomy for advanced gastric cancer.
Methods:The retrospective cohort study was adopted. The clinical data of 112 patients with advanced gastric cancer who were admitted to the Wuhan Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2012 to June 2015 were collected. The neoadjuvant chemotherapy was selectively performed based on patients′ decisions. Of 112 patients, 42 receiving neoadjuvant chemotherapy combined with laparoscopyassisted radical gastrectomy (NCLAG) were allocated into the NCLAG group and 70 receiving laparoscopyassisted radical gastrectomy (LAG) without neoadjuvant chemotherapy were allocated into the LAG group. Patients in the NCLAG group underwent LAG at 4 weeks after neoadjuvant chemotherapy of ²-4 cycles FOLFOX6 regimen. The efficacy of neoadjuvant chemotherapy was divided into the complete remission (CR),  partial remission (PR), stable disease (SD) and progressive disease (PD) based on the Response Evaluation Criteria in Solid Tumors (RECIST). Clinical response rate=［(number of patients with CR+number of patients with PR)/number of measurable patients］×100%，disease control rate=［(number of patients with CR+number of patients with PR+number of patients with SD)/number of measurable patients］×100%. The adverse reactions were observed during neoadjuvant chemotherapy and were divided into the grade 0, Ⅰ, Ⅱ, Ⅲ, and Ⅳ based on the grading standards for common adverse drug reactions of anticancer drugs issued by World Health Organization (WHO). The distal or total gastrectomy was selected according to tumor location. Observation indicators included (1) efficacy of neoadjuvant chemotherapy and grading of adverse reaction, (2) surgical situations, (3) postoperative recovery, (4) prognosis. The followup of outpatient examination and telephone interview was performed to detect the survival of patients and tumors recurrence and metastasis up to December 2015. The measurement data with normal distribution was presented as  ±s. The comparison between groups was evaluated with the t test, and the count data were analyzed using the chisquare test and nonparametric test.
Results(1) Efficacy of neoadjuvant chemotherapy and adverse reaction: of 42 patients in the NCLAG group, 12 had tumor downstaging, and 2, 16, 20 and 4 had respectively CR, PR, SD and PD, with the clinical response rate of 42.9%(18/42) and disease control rate of 90.5%(38/42). Five, 23, 12, 2 and 0 patients had respectively grade 0, Ⅰ, Ⅱ, Ⅲ, and Ⅳ of adverse reactions and were improved after symptomatic treatment, without occurrence of chemotherapyrelated death. (2) Surgical situations: number of patients with palliative operation, number of patients with R0 resection and with R1 or R2 resection were 3, 34 , 5 in the NCLAG group and 11, 44, 15 in the LAG group, respectively, with significant difference between the 2 groups (χ²=4.066, P<0.05). (3) Postoperative recovery: recovery time of gastrointestinal function and duration of hospital stay were respectively (3.1±1.2)days and (13±4)days in the NCLAG group and (2.8±0.9) days and (13±4)days in the LAG group. Four, 3, 1, 0, 1, 0, 1, 0, 1, 0, 0 and 1 patients in the NCLAG group and 5, 2, 2, 1, 0, 1, 1, 1, 1, 1, 1, and 0 patients in the LAG group were respectively complicated with incisional infection, pulmonary infection, pleural effusion, anastomotic fistula, anastomotic hemorrhage, delayed gastric emptying, duodenal stump fistula, intestine obstruction,  intraperitoneal infection,  intraperitoneal hemorrhage, endolymphatic leakage and thrombosis. There were no significant differences in the recovery time of gastrointestinal function, duration of hospital stay and number of patients with complications between the 2 groups (t=1.114, 0.416, χ²=0.457, P>0.05）. Of 112 patients, 103 were followed up for a median time of 22 months (ranges, 6-45 months), 5 in the NCLAG group and 11 in the LAG group were dead, 9 in the NCLAG group and 17 in the LAG group had tumors recurrence and metastasis.
ConclusionNeoadjuvant chemotherapy is safe and feasible after LAG for advanced gastric cancer, and it can effectively reduce the clinical stage of gastric cancer and improve the R0 resection rate.