Objective:To investigate the application value of laparoscopy for stage Ⅳ gastric cancer after transformation therapy.Methods:The clinical data of 7 patients with advanced gastric cancer who underwent laparoscopic surgery after transformation therapy in the First Affiliated Hospital of Hebei North University from January 2016 to December 2020 were retrospectively analyzed. Seven patients were diagnosed as stage Ⅳ gastric cancer by computed tomography (CT), positron emission tomography (PET-CT) and laparoscopy, and underwent paclitaxel based conversion therapy. After evaluating the curative effect, they underwent surgical resection. The intraoperative and postoperative conditions and survival rate of the patients were analyzed.Results:After transformation therapy, 6 patients (85.7%) had partial remission, 1 patient (14.3%) had stable disease, and the overall effective rate was 6/7. Laparoscopic-assisted surgery was performed in 3 patients, and 4 patients were converted to laparotomy. The operation time was (297.9±35.6)min, the intraoperative blood loss was (257.0±106.0)ml, the number of dissected lymph nodes was (38.4±9.1), the gastric tube indwelling time was (72.4±9.6)h, the jejunal feeding tube indwelling time was (15.4±5.6)d, and the liquid diet time was (8.6±3.4)d, the length of hospital stay was (17.1±5.5)d. The postoperative complication rate was 3/7, and there were no unplanned secondary operations and deaths. R0 resection was performed in 6 cases, and R1 resection in 1 case. Tumor regression grade (TRG) classification: 5 cases were grade 2 and 2 cases were grade 3. The median progression free survival of the 7 patients was 15.3 months, the median overall survival was 21.6 months, and the 1-year survival rate was 6/7.Conclusions:Laparoscopy has irreplaceable value in the staging and efficacy judgment of transformation therapy for gastric cancer. However, after transformation therapy, the tissue edema increases, the tumor boundary becomes more unclear, and the surgical operation becomes more difficult. Therefore, it is not necessary to force the laparoscopic operation, and switch to laparotomy according to the situation.

OBJECTIVETo evaluate the short-term efficacy and safety of neoadjuvant synchronous chemoradiotherapy (paclitaxel plus carboplatin regimen) in stage III adenocarcinoma of esophagogastric junction (AEG).

METHODSForty cases clinically diagnosed as stage III AEG were prospectively enrolled at the Department of Gastrointestinal Oncology Surgery, the First Affiliated Hospital of Hebei North University from December 2014 to November 2017 and then were randomly divided into paclitaxel plus carboplatin combined with synchronous radiotherapy group(neoadjuvant group) and direct operation group. Inclusion criteria was as follows:(1) AEG was diagnosed by gastroscopic biopsy and III stage was confirmed by ultrasound endoscopy and spiral CT;(2) physical strength score ≥70, and age ≤75 years old; (3) no contraindications of chemoradiotherapy and operation. Exclusion criteria was as follows:(1) patients voluntarily withdrew or refused the treatment;(2) occurrence of severe anaphylaxis; (3) uncontrollable events happened during treatment and treatment was unable to continue;(4) tumor developed obviously during treatment. Preoperative neoadjuvant synchronous chemoradiotherapy used TP regimen: paclitaxel 80 mg/m², drug concentration-time area under curve of carboplatin= 1.5 mg×ml⁻¹×min⁻¹, once per week for 9 weeks; radiotherapy began at the second week, 40 Gy/20 F, completed within 4 weeks. Operative procedure of both groups was radical resection of cardiac cancer(D2). Postoperative chemotherapy regimen was oral Tegafur(Gimeracil and Oteracil potassium). The side effects, diet situation, change of gastroscopic image after treatment in patients of neoadjuvant group were observed and efficacy evaluation of chemotherapy was performed according to solid tumor efficacy evaluation criteria of US National Cancer Institute. Operation-associated parameters, including R0 resection rate, lymph node metastasis, operative mortality and postoperative complications, were compared between two groups.

RESULTSThere were no significant differences in baseline information between the two group (all P>0.05). One case in neoadjuvant group was excluded because of perforation at lesion site 7 weeks after chemotherapy. The side effects of 19 cases in neoadjuvant group were mainly alopecia (100%) and marrow inhibition (68.4%), while 3-4 degree side effects were alopecia(8/19,42.1%), leukopenia (3/19, 15.8%) and neutropenia(3/19, 15.8%). Complete remission was observed in 4 cases; partial remission was observed in 13 cases and stable disease in 2 cases, with an objective response rate of 89.5% and a disease control rate of 100%. Before neoadjuvant chemotherapy, 16 cases were difficult to take liquid diet and 3 cases received liquid diet only, while after 12 weeks of neoadjuvant chemotherapy, all the 19 cases received normal diet. Besides, after neoadjuvant chemotherapy, gastroscopic examination showed close healing of cardiac ulcer, disappearance of swelling, and renewal of normal mucosa. Compared to direct operation group, neoadjuvant group had less number of positive lymph node (4.9±3.6 vs. 8.8±2.8, P<0.05) and higher R0 resection rate (94.7% vs. 50.0%, P<0.05). Total number of harvested lymph node was not significantly different between two groups (19.1±2.5 vs. 18.6±7.0, t=0.326, P=0.746). There was no surgical death in either group. One case in direct operation group developed postoperative inflammatory obstruction. No associated complication was found in neoadjuvant group.

CONCLUSIONPaclitaxel plus carboplatin combined with synchronous radiotherapy can elevate the R0 resection rate of patients with stage III esophagogastric junction adenocarcinoma, without increasing operative mortality and postoperative complications.

Adenocarcinoma ; drug therapy ; therapy ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carboplatin ; administration & dosage ; Chemoradiotherapy ; Esophageal Neoplasms ; therapy ; Esophagogastric Junction ; Humans ; Neoadjuvant Therapy ; Neoplasm Staging ; Paclitaxel ; administration & dosage ; Stomach Neoplasms ; therapy ; Survival Rate