Neoadjuvant Chemotherapy Can Effectively Avoid Unnecessary Extended Resection for Gastric Cancer with Clinical Evidence of Duodenum or Pancreas Head Involvement.

Abstract

Purpose: This study aims to compare the efficacy of two treatment strategies for gastric cancer with clinical evidence of pancreatic head or duodenal involvement: gastrectomy combined with pancreaticoduodenectomy (GPD) and neoadjuvant chemotherapy followed by surgery (NCS). Methods: A retrospective analysis of patient data from January 2012 to January 2022 was conducted to evaluate the outcomes of these two treatment strategies. Results: The study included 284 patients, comprising 78 in the GPD group and 206 in the NCS group. In the NCS group, 119 patients required extended pancreaticoduodenectomy, a significantly smaller proportion compared to the GPD group (p < 0.001). The NCS group successfully avoided unnecessary extended pancreaticoduodenectomy. In contrast, 15 patients in the GPD group underwent surgery despite postoperative pathological confirmation of no pancreatic head or duodenal involvement (p < 0.001). The incidence of Clavien-Dindo grade ≥ IIIb complications was significantly greater in the GPD group than in the NCS group (10.3% vs. 3.3%, p = 0.034). Overall survival was significantly longer in the NCS group, with a median of 25 months compared to 20 months in the GPD group (p = 0.0005). Multivariate Cox regression analysis revealed that tumor diameter ≥7 cm and N3 stage were independent adverse prognostic factors. Conclusion: Neoadjuvant chemotherapy is recommended for patients with gastric cancer presenting clinical evidence of pancreatic head or duodenal involvement. This approach reduces unnecessary extended surgeries, lowers complication rates, and improves overall survival.