Neoadjuvant Chemotherapy plus Surgery versus Direct Surgery in Senile Patients with with Gastric Cancer: Single-Center Retrospective Cohort Study

Abstract

Abstract Background Despite the lack of decisive research advocating neoadjuvant chemotherapy there is a broad consensus that it is beneficial for gastric cancer in terms of survival. However, there is no comparative research on whether it is similarly helpful in senile patients with the age above 75 years old. Here we compared the survival rate between neoadjuvant plus surgery with Direct Surgery. Methods We analyzed 79 patients with locally advanced gastric cancer who were preoperatively suspicious of serosa positive or beyond (cT4a or cT4b); or extensive lymph node involvement (cN3). Postoperative complications and overall survival rate were compared between the patients who underwent neoadjuvant chemotherapy (NAC) plus surgery and the patients who had direct surgery. Results A total of 15 (19%) patients underwent neoadjuvant chemotherapy and 64 (81%) patients had direct surgery. The median follow-up time was 34 months (range of 24–60 months). While the median survival time was not reached in the direct surgery group, the median survival time for the NAC plus Surgery Group was 37 months. Two years of overall survival (OS) for the patients in the NAC plus Surgery group and direct surgery group were 53.3% and 70.3% respectively. There was no statistical difference between the two groups (p > 0.05) in overall postoperative complication and length of postoperative stay. Conclusions Reduced does of neoadjuvant chemotherapy was feasible in senile patients. There was no difference in survival rate between the patients who had neoadjuvant plus surgery compared to those who had direct surgery. While this result contradicts the previous assumption that neoadjuvant chemotherapy is beneficial for late-stage gastric cancer patients, a well-controlled prospective study is mandatory for a better understanding of whether neoadjuvant chemotherapy is beneficial to senile patients too.