Surgery for Locally Advanced Gastric Cancer in the Era of Neo-adjuvant Therapies: something new?

Abstract

Abstract Purpose: Locally advanced gastric cancer (LAGC) represents a therapeutic challenge. The aim of this study was to analyze prognostic factors influencing survival and surgical strategies and possible influence of neoadjuvant chemotherapy over a ten-years experience in a tertiary Western center. Methods: Between January 2010 and December 2020, the medical records of 113 patients with LAGC who underwent curative resection were retrospectively reviewed. Patient characteristics, related complications, long-term survival, and prognostic factors were analyzed at uni- and multivariate analyses. Results: Multivariate analysis revealed that neoadjuvant therapy, completeness of resection (R0), number of lymph nodes retrieved, N status and the adoption of HIPEC were independent prognostic factors associated with longer survival. Five-year overall survival for NAC group and upfront surgery group was 46% and 32%, respectively (p=0.04). Five-year disease-free survival for NAC group and upfront surgery group was 38% and 25%, respectively (p=0.02). Conclusion: Patients with LAGC undergoing surgery plus neoadjuvant therapy had a better OS and DFS respect to patients undergoing upfront surgery. No difference was observed in terms of surgical strategy.