Neoadjuvant chemotherapy in conjunction with D2 gastrectomy for management of locally advanced gastric adenocarcinoma: a specialized unit experience

Background
Gastric carcinoma is ranked the fourth most diagnosed cancer worldwide. In Egypt, it represents 1.8% of all types of cancers with male predilection. Most of the patients are diagnosed late, with poor prognosis. The effect of neoadjuvant chemotherapy has been discussed in literature with various outcomes.
Aim
The aim of this study was to evaluate the outcome of preoperative chemotherapy (XELOX) in conjunction with D2 gastrectomy in the management of locally advanced gastric adenocarcinomas in our specialized upper gastrointestinal track surgery unit with respect to response to neoadjuvant treatment, postoperative complications, resection margins, progression-free survival, and recurrence.
Patients and methods
A prospective cohort observational study was done on 25 patients who presented to Ain Shams University Hospitals at the upper gastrointestinal track surgery, oncology, and internal medicine outpatient clinics with locally advanced gastric adenocarcinoma stage III and IVa according to the 8th edition of American Joint Committee on Cancer for gastric carcinoma, from January 2017 to January 2019 with 24 months of follow-up. All patients followed our unit’s protocol in receiving neoadjuvant chemotherapy after multidisciplinary team revision of the cases for preoperative downstaging of the tumor.
Results
A total of 25 patients started neoadjuvant chemotherapy. Overall, 10 (40%) patients showed partial response, seven (28%) patients had a stable disease, and eight (32%) patients showed progression of the tumor, where two of them developed metastasis. A total of 23 (92%) patients underwent surgery after four cycles of neoadjuvant treatment, 18 (78.3%) underwent D2 gastrectomy, four (17.4%) had palliative resection, and one (4.3%) was irresectable. R0 was noticed in 18 (81.8%) patients and R1 in four (18.2%) patients. Recurrence occurred in seven (43.75%) patients during a 2-year follow-up period, with median progression-free survival of 17.5 ± 6.9 months (45.3%). The median survival after 2 years of follow-up was 18 ± 6.5 months (56%).
Conclusion
Despite the modest effect of neoadjuvant treatment on downstaging locally advanced gastric adenocarcinoma, the clinical outcome regarding R0 resection is satisfactory, with an acceptable recurrence rate. We did not consider survival rate as an end point owing to the short-term follow-up period.