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Radical D2 gastrectomy with adjuvant chemotherapy for stage IB/II/III distal gastric cancers in the era of perioperative chemotherapy: A propensity matched comparison

  • Hemant Kumar Singh
    Affiliations
    Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, Maharashtra, India

    Department of Surgical Oncology, All India Institute of Medical Sciences, Mangalagiri, Guntur, 522503, India
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  • Vikram Chaudhari
    Affiliations
    Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, Maharashtra, India
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  • Swati Batra
    Affiliations
    Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, Maharashtra, India
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  • Vikas Ostwal
    Affiliations
    Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, Maharashtra, India
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  • Anant Ramaswamy
    Affiliations
    Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, Maharashtra, India
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  • Smruti Mokal
    Affiliations
    Clinical Research Secretariat, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, Maharashtra, India
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  • Shailesh V. Shrikhande
    Affiliations
    Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, Maharashtra, India
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  • Manish S. Bhandare
    Correspondence
    Corresponding author. Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, 400012, Maharashtra, India.
    Affiliations
    Gastrointestinal and Hepato-Pancreato-Biliary Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012, Maharashtra, India
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Published:October 26, 2021DOI:https://doi.org/10.1016/j.amjsurg.2021.10.036

      Highlights

      • Proximal and distal gastric cancers are biologically different but landmark trials have not segregated these.
      • The best approach for distal gastric cancer is debated.
      • There was no difference in OS and DFS between the perioperative and Upfront resection with adjuvant chemotherapy groups.

      Abstract

      Aim

      This study aimed to assess the impact of treatment sequencing on long-term survival, in distal gastric cancers (GCs) (stage IB/II/III).

      Methods

      This retrospective study included patients with distal GC undergoing D2 resection. Outcomes were compared between group 1 (surgery with adjuvant chemotherapy) and group 2 (perioperative chemotherapy with surgery). 1:1 matching for baseline characteristics (age, cT, and cN stage) was performed for outcome comparison.

      Results

      At a median follow-up of 47.5 months in the included 342 patients, the 5-year overall survival (OS) was 61.1% and disease-free survival (DFS) was 50.5%. OS was comparable in the unmatched (group 1, n = 118; group 2, n = 224) (HR 0.905, 95%CI 0.64–1.33, P = 0.615) and matched groups (group 1, n = 97; group 2, n = 97) (HR 0.77, 95% CI 0.48–1.26, P = 0.3).

      Conclusion

      D2 resection followed by adjuvant chemotherapy provides similar long-term outcomes as compared to perioperative chemotherapy approach for stage IB/II/III distal GCs.

      Keywords

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