Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2023; 15(8): 1808-1818
Published online Aug 27, 2023. doi: 10.4240/wjgs.v15.i8.1808
Comparison between upfront surgery and neoadjuvant chemotherapy in patients with locally advanced gastric cancer: A systematic review
Stylianos Fiflis, Menelaos Papakonstantinou, Alexandros Giakoustidis, Gregory Christodoulidis, Eleni Louri, Vasileios N Papadopoulos, Dimitrios Giakoustidis
Stylianos Fiflis, Menelaos Papakonstantinou, Alexandros Giakoustidis, Eleni Louri, Vasileios N Papadopoulos, Dimitrios Giakoustidis, A’ Department of Surgery, General Hospital Papageorgiou, Thessaloniki 56429, Greece
Gregory Christodoulidis, Department of General Surgery, University Hospital of Larissa, Larissa 41110, Greece
Author contributions: Fiflis S designed and performed the research and wrote most of the manuscript; Papakonstantinou M performed the research, analyzed the data and wrote part of the results and the discussion; Giakoustidis A resolved conflicts during the article screening, offered guidance and performed manuscript revisions; Christodoulidis G perceived the idea, performed manuscript revisions and assisted as a corresponding author; Louri E wrote part of the discussion and performed manuscript revisions; Papadopoulos VN performed manuscript revisions; Giakoustidis D offered guidance and assisted as a supervising author; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 checklist, and the manuscript was prepared and revised according to the PRISMA 2009 checklist.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gregory Christodoulidis, PhD, Surgeon, Department of General Surgery, University Hospital of Larissa, Mezourlo, Larissa 41110, Greece. gregsurg@yahoo.gr
Received: April 24, 2023
Peer-review started: April 24, 2023
First decision: June 1, 2023
Revised: June 7, 2023
Accepted: June 27, 2023
Article in press: June 27, 2023
Published online: August 27, 2023
Processing time: 122 Days and 18.9 Hours
ARTICLE HIGHLIGHTS
Research background

Gastric cancer (GC) is a major health concern worldwide. Currently, surgery is the mainstay treatment along with adjuvant or neoadjuvant chemotherapy (NAT) or both. However, in locally advanced GC (LAGC) upfront surgery (US) may not be the optimal approach. NAT may induce tumor downsizing and therefore offer better chances for complete resection of the tumor.

Research motivation

NAT could lead to complete surgical resection of the otherwise unresectable LAGC. Unfortunately, in the current literature, there are conflicting results regarding the role of NAT in the survival of patients with LAGC. We aim to investigate that role and hopefully, future research could focus on optimizing the treatment strategy of LAGC.

Research objectives

In our systematic review we aim to investigate the effects of NAT on the overall survival (OS), the disease-free survival (DFS), the morbidity and the mortality of patients with LAGC in comparison to US. The results of our review may add to the effort of optimizing the treatment strategy for cancer patients regarding longer survival with better quality of life.

Research methods

We conducted a thorough literature search for cohort studies comparing patients with LAGC treated with US to patients treated with NAT followed by surgery. The patients’ characteristics were not statistically significantly different before the interventions and only the matched group results were included in our study.

Research results

The OS of patients with LAGC was slightly better in the groups treated with NAT than those undergoing US. Similar results were also found for DFS. Whatsmore mortality rates were higher in the US groups. These results are promising regarding the utilization of NAT in the treatment of LAGC. In the future, research on LAGC should include more patients treated in large centers with similar surgical techniques and focus on investigating the optimal NAT regimens that lead to longer survival with minimal complications.

Research conclusions

NAT may lead to complete surgical resection of LAGC and therefore offers the potential for treatment for patients with otherwise unresectable tumors.

Research perspectives

To clarify which patients will benefit more from which NAT regimen and also investigate the potential role of immune-targeted therapies or other biological agents in treating patients with LAGC.