Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2020; 12(5): 559-568
Published online May 15, 2020. doi: 10.4251/wjgo.v12.i5.559
Perioperative chemotherapy for advanced gastric cancer - results from a tertiary-care hospital in Germany
Katrin Bauer, Giulia Manzini, Doris Henne-Bruns, Peter Buechler
Katrin Bauer, Peter Buechler, Department for General, Visceral, Thoracic and Paediatric Surgery, Clinic of Kempten, Kempten 87439, Germany
Giulia Manzini, Doris Henne-Bruns, Department of General and Visceral Surgery, University Hospital of Ulm, Ulm 89081, Germany
Author contributions: Bauer K and Manzini G contributed equally to this work; Bauer K, Manzini G, Henne-Bruns D and Buechler P designed the research; Bauer K, Manzini and Buechler P performed the research; Bauer K, Manzini G and Henne-Bruns D analysed the data; Manzini G worked out the statistics; Bauer K, Manzini G and Henne-Bruns D wrote the paper; Bauer K and Manzini G are responsible for the final approval of the paper.
Institutional review board statement: According to consultation with the Federal Medical Association the institutional review board stated that it was not necessary to obtain a decision by the Ethics Commission for this retrospective analysis of our internal hospital data.
Informed consent statement: For the analysis of our internal hospital data an informed consent statement was not necessary.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Katrin Bauer, MD, Doctor, Surgeon, Department for General, Visceral, Thoracic and Paediatric Surgery, Clinic of Kempten, Robert-Weixler Strasse 50, Kempten 87439, Germany. katrin_joerg@gmx.de
Received: November 27, 2019
Peer-review started: November 27, 2019
First decision: December 26, 2019
Revised: March 18, 2020
Accepted: April 8, 2020
Article in press: April 8, 2020
Published online: May 15, 2020
Processing time: 168 Days and 11.8 Hours
Abstract
BACKGROUND

Neoadjuvant/perioperative chemotherapy is the recommended treatment for advanced stages of gastric cancer (> T2, N+) before tumour resection in many European guidelines. However, there is no consensus as to whether perioperative chemotherapy is as effective in distal as in proximal tumours, in addition to a relevant uncertainty concerning appropriate treatment modalities for elderly patients.

AIM

To investigate the role of perioperative chemotherapy in advanced gastric cancer in patients from a German tertiary clinic with respect to efficacy, localisation, and age.

METHODS

We performed a retrospective analysis of 158 patients from our clinic with adenocarcinoma of the stomach or the gastroesophageal junction who underwent resection between 2008 and 2016. The data were evaluated particularly in relation to patient age, tumour site, and perioperative therapy.

RESULTS

Administration of perioperative chemotherapy did not lead to a significant survival advantage in our study population. The 5-year survival rates were 40% for patients who received perioperative chemotherapy and 29% for the group without perioperative chemotherapy (P = 0.125). Our patients were on average distinctly older than patients in most of the published randomised controlled trials. Patients elder than 75 years received perioperative chemotherapy far less frequently. Patients with a proximal tumour received perioperative chemotherapy much more often.

CONCLUSION

This analysis reconfirms our previous data concerning the effectiveness of perioperative chemotherapy for advanced gastric cancer. There is reasonable doubt that the quality of the existing randomized controlled trials is sufficient to generally justify perioperative chemotherapy in patients with advanced gastric cancer independent of tumour localization or age.

Keywords: Gastric cancer; Perioperative; Chemotherapy; Tumour localisation; Age distribution; Validity

Core tip: Due to the unfavourable prognosis of locally advanced gastric carcinoma, multimodal therapy has been propagated worldwide in the last decade. European guidelines recommend perioperative chemotherapy on the basis of a few randomized trials, which are of limited validity for certain reasons. These studies had shown a better 5-year overall survival of approximately 15%, but neither the studies nor guidelines focused on the age and tumour localization of the patients. The goal of our study was to compare the observed effects of randomized controlled studies with real life data from a German community hospital with a focus on patient age and tumour localization.