[1]刘庆国 沈荐① 马晓龙 李敏哲**①.替吉奥与奥沙利铂新辅助化疗联合腹腔镜手术治疗进展期胃癌[J].中国微创外科杂志,2018,18(11):969-992.
　Liu Qingguo*,Shen Jian,Ma Xiaolong*,et al.Clinical Efficacy of S1 Plus Oxaliplatine (SOX) Regimen Neoadjuvant Chemotherapy Combined With Laparoscopicassisted Radical Gastrectomy for Advanced Gastric Cancer[J].Chinese Journal of Minimally Invasive Surgery,2018,18(11):969-992.
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替吉奥与奥沙利铂新辅助化疗联合腹腔镜手术治疗进展期胃癌()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
18
期数:
2018年11期
页码:
969-992
栏目:
临床论著
出版日期:
2018-11-20

文章信息/Info

Title:
Clinical Efficacy of S1 Plus Oxaliplatine (SOX) Regimen Neoadjuvant Chemotherapy Combined With Laparoscopicassisted Radical Gastrectomy for Advanced Gastric Cancer
作者:
刘庆国 沈荐① 马晓龙 李敏哲**①
（唐山市工人医院胃肠外科，唐山063000）
Author(s):
Liu Qingguo*;  Shen Jian;  Ma Xiaolong*;  et al.
*Department of Gastrointestinal Surgery, Tangshan Workers’ Hospital, Tangshan 063000, China
关键词:
胃癌; 胃切除术; 腹腔镜手术; 新辅助化疗; SOX方案
Keywords:
Gastric cancer; Gastrectomy; Laparoscopy; Neoadjuvant chemotherapy; SOX regimen
文献标志码:
A
摘要:
目的评估SOX方案（替吉奥+奥沙利铂）新辅助化疗联合腹腔镜辅助胃癌根治术治疗进展期胃癌的临床疗效。方法2014年1月~2016年12月我科71例进展期胃癌根据患者意愿是否行新辅助化疗分为2组，34例术前给予SOX方案新辅助化疗后行腹腔镜手术为新辅助组，37例直接行腹腔镜手术为手术组。观察新辅助化疗的疗效及不良反应分级，比较2组手术情况、术后恢复情况、术后病理及预后情况。结果新辅助组26例完成4周期化疗，8例完成2周期化疗，化疗后完全缓解3例，部分缓解15例，疾病稳定14例，疾病进展2例，有效率529%（18/34），疾病控制率941%（32/34）；3~4级不良反应主要为恶心呕吐（235%，8/34）、中性粒细胞减少（59%，2/34）、贫血（59%，2/34）。新辅助组3例发现腹腔广泛转移，手术组7例，此10例行开关术，新辅助组31例、手术组30例行根治性手术。新辅助组手术R0切除率明显高于手术组［882%(30/34) vs 676% (25/37)， χ2=4336，P=0337］；2组中转开腹率［97%(3/31) vs 100%(3/30)， χ2=0000，P=1000］、手术时间［(2558±292)min vs (2610±326)min，t=-0657, P=0514］、术中出血量［(1516±851) ml vs (1417±696)ml，t=0499，P=0620］、术中输血率［774%(24/31) vs 700%(21/30)， χ2=0434，P=0510］、淋巴结清扫 ［(211±34)枚 vs (227±42)枚，t=-1589，P=0117］、术后胃肠功能恢复时间［(31±10)d vs (30±08)d，t=0421，P=0675］、术后住院时间［(147±40)d vs (155±42)d，t=-0749，P=0457］和术后并发症发生率［452%（14/31） vs 433%（13/30）， χ2=0021，P=0886］无显著性差异。新辅助组术后病理肿瘤浸润深度（χ2=10926，P=0027）、淋巴结转移分级（χ2=8724，P=0033）明显优于手术组。2组累积生存率无显著性差异（χ2=2488，P=0115）。结论进展期胃癌行腹腔镜胃癌根治术，术前行SOX方案新辅助化疗是安全可行的，可以有效降低进展期胃癌临床分级分期，提高R0切除率。
Abstract:
ObjectiveTo evaluate the clinical efficacy of Ｓ１ plus oxaliplatine (SOX) regimen neoadjuvant chemotherapy combined with laparoscopicassisted radical gastrectomy for advanced gastric cancer.MethodsClinical data of 71 patients with advanced gastric cancer admitted to our hospital between January 2014 and December 2016 were included. The neoadjuvant chemotherapy was selectively performed based on patients’ decisions. There were 34 patients receiving SOX regimen neoadjuvant chemotherapy combined with laparoscopicassisted radical gastrectomy as neoadjuvant group, while 37 patients receiving laparoscopicassisted radical gastrectomy only as surgery group. The efficacy and adverse reactions of neoadjuvant group were observed. Surgical situations, postoperative recovery, postoperative pathology and prognosis were compared between the two groups.ResultsIn the neoadjuvant group, 26 patients completed 4 cycles of chemotherapy and 8 patients completed 2 cycles of chemotherapy. There were 3 cases of complete response, 15 cases of partial response, 14 cases of stable disease, and 2 cases of progress disease, respectively. The clinical response rate was 52.9% (18/34) and the disease control rate was 94.1% (32/34). The grade 3 or 4 hematological toxicities were nausea and vomitting (23.5%, 8/34), neutropenia (5.9%, 2/34), and anemia (5.9%, 2/34). All the patients were given laparoscopic exploration firstly. Extensive abdominal metastases were found in 3 cases in the neoadjuvant group and 7 cases in the surgery group, and abdominal closure was performed in these 10 cases. Radical gastrectomy was performed in 31 cases in the neoadjuvant group and 30 cases in the surgery group. The R0 resection rate in the neoadjuvant group was significantly higher than that in the surgery group ［88.2% (30/34) vs. 67.6% (25/37), χ2=4.336, P=0.337］. There were no significant differences in conversion to laparotomy ［9.7% (3/31) vs. 10.0% (3/30), χ2=0.000, P=1.000］, operation time［(255.8±29.2) min vs. (261.0±32.6) min, t=-0.657, P=0.514］, intraoperative bleeding ［(151.6±85.1) ml vs. (141.7±69.6) ml, t=0.499, P=0.620］, intraoperative blood transfusion ［77.4% (24/31) vs. 70.0% (21/30), χ2=0.434, P=0.510］, lymph node dissection ［(21.1±3.4) vs. (22.7±4.2), t=-1.589, P=0.117］, recovery time of gastrointestinal function ［(3.1±1.0) d vs. (3.0±0.8) d, t=0.421, P=0.675］, postoperative hospital stay ［(14.7±4.0) d vs. (15.5±4.2) d, t=-0.749, P=0457］, and postoperative complications ［45.2% (14/31) vs. 43.3% (13/30), χ2=0021, P=0.886］ between the two groups. Postoperative pathology showed neoadjuvant group had significantly better results than those in the surgery group in primary tumor infiltration (χ2=10.926, P=0.027) and regional lymph nodes (χ2=8.724, P=0033). The two groups had no significant difference in cumulative survival rate (χ2=2.488, P=0.115).ConclusionSOX regimen neoadjuvant chemotherapy is safe and feasible before laparoscopicassisted radical gastrectomy for advanced gastric cancer, and it can effectively reduce the clinical stage of gastric cancer and improve the R0 resection rate.

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备注/Memo

备注/Memo:
＊基金项目：唐山市科技计划项目（17130221a）**通讯作者，Email:124104561@qq.com① （首都医科大学附属北京朝阳医院普外科，北京100020）
更新日期/Last Update: 2019-03-01