PERIOPERATIVE FLOT CHEMOTHERAPY FOR GASTRIC CANCER: A RETROSPECTIVE SINGLE-CENTER COHORT TRIAL.

Abstract

Aim: to analyze the short- and long-term outcomes of surgical treatment of patients with gastric cancer who received perioperative chemotherapy (PCT) FLOT (fluorouracil, leucovorin, oxaliplatin and docetaxel).

Materials and methods: A retrospective cohort study included 146 patients who received surgical treatment at the Faculty Surgery Clinic of Sechenov University for gastric cancer (GC) and/or EGJC Sievert Type II-III in the period from January 2018 to December 2022. The main group consisted of 28 patients who received PCT FLOT; there were 118 patients operated "up front" in control group. Patients in both groups did not statistically differ in average age (p=0.110), ASA (p=0.541) and ECOG (p=0.12) status, localization (p=0.063), depth of invasion (p=0.099) and histological structure of tumor (p=0.787).

Results: In 92.9% of the patients in the main group and in 94.9% of the control group, R0 resection margins (p=0.750) were achieved. The number of dissected lymph nodes was statistically significantly higher in the main group (average 26 vs 21; p=0.010). There was no difference in intraoperative blood loss (p=0.294) and time of hospital stay (p=0.992); the average duration of surgery in the main group was 319 minutes, compared to 250 minutes in the control group (p<0.001). In the early postoperative period, the total number of complications (CD Ⅰ-IV) was higher in the main group (p=0.031), however, there was no difference in the number of minor (CD Ⅰ-Ⅱ; p=0.094) and significant (CD III-V; p=0.142) complications. Postoperative mortality in the first 30 days after the surgical treatment was 3.6% and 2.5% in the main and control groups, respectively (p=0.764). The overall 6-month survival rate in the control group was 95.9% vs 90.9% in the main group, and the 12-month survival rate was 88.8% vs 75.7%, respectively. The reccurence-free 6-month survival rate in the control group was 96%, in the main group - 100%; the reccurence-free 12-month survival rate in the control group was 92.1%, in the PCT group - 93.3%.

Conclusion: PCT FLOT in the treatment of GC does not increase the level of intraoperative blood loss, the number of postoperative complications and the duration of hospital stay. The 6-month and one-year survival rates did not differ in the two groups. Considering that the majority of patients in the PCT group belonged to the cN+ category, with an initially less favorable treatment prognosis, it can be assumed that comparable survival results were achieved thanks to PCT.