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目的评价新辅助化疗联合腹腔镜治疗进展期胃癌的临床疗效。方法 2012年7月至2015年7月期间对我科24例局部进展期胃癌患者行2周期FLEEOX新辅助化疗,根据影像学观察病灶变化,化疗结束后2周内接受腹腔镜手术治疗。患者术后接受XELOX化疗方案6个疗程。结果①化疗有效率:病灶完全缓解者4例(16.6%),部分缓解者18例(75.0%),疾病稳定者1例(4.2%),疾病进展者1例(4.2%),临床总有效率为91.6%(22/24)。②化疗前后血液肿瘤标志物变化:CEA、CA19-9及CA125指标在化疗后均明显低于化疗前水平(P<0.001)且在正常参考范围内。③手术情况:24例患者均完成2个疗程新辅助化疗后接受了腹腔镜探查手术。有2例患者因腹腔内广泛转移仅行姑息性胃空肠吻合术,其余22例患者接受腹腔镜下D2手术。手术时间(236±45)min,术中出血量(150±50)m L,淋巴结清扫数目(17.4±5.3)枚,胃肠道功能恢复时间(3.1±0.8)d。④术后并发症:无因手术死亡者,发生吻合口漏1例,肠梗阻1例,肺部感染1例,所有患者术后并发症经保守治疗后治愈。⑤毒副反应:9例患者血红蛋白下降,14例患者白细胞降低,8例血小板降低,5例患者ALT升高,6例患者AST升高。19例患者出现恶心症状。10例患者出现手足麻木等神经毒副反应,经治疗后缓解。⑥随访结果:截止到2015年11月,随访4~39个月,1例患者腹腔广泛转移而死于恶病质,1例患者出现肝脏多发转移而死于肝功能衰竭,1例患者出现脑转移而死亡,1例患者因其他疾病死亡,剩余20例患者仍存活。随访中无切口及戳孔种植性转移发生。结论从本组有限的数据初步得出,FLEEOX新辅助化疗方案联合腹腔镜治疗局部进展期胃癌安全、有效,具有创伤小、术后恢复快的特点。
Objective To evaluate the clinical effect of neoadjuvant chemotherapy combined with laparoscopy in the treatment of advanced gastric cancer. Methods From July 2012 to July 2015, 24 patients with locally advanced gastric cancer in our department underwent 2-cycle FLEEOX neoadjuvant chemotherapy. The changes of lesions were observed according to the imaging findings. Laparoscopic surgery was performed within 2 weeks after the end of chemotherapy. Patients received six courses of XELOX chemotherapy after surgery. Results (1) Chemotherapy efficiency: 4 patients (16.6%) had complete remission, 18 patients (75.0%) had partial remission, 1 patient (4.2%) had stable disease and 1 patient (4.2% Efficiency was 91.6% (22/24). Changes of hematological tumor markers before and after chemotherapy: CEA, CA19-9 and CA125 were significantly lower than those before chemotherapy after chemotherapy (P <0.001) and within the normal reference range. Â ’¢ surgical conditions: 24 patients completed two courses of neoadjuvant chemotherapy after laparoscopic surgery. Two patients underwent palliative gastrojejunostomy due to extensive intraperitoneal transfer, and the remaining 22 underwent laparoscopic D2 surgery. The operative time (236 ± 45) min, intraoperative blood loss (150 ± 50) m L, number of lymph node dissection (17.4 ± 5.3) and gastrointestinal function recovery time (3.1 ± 0.8) d. ④ postoperative complications: no death due to surgery, anastomotic leakage occurred in 1 case, 1 case of intestinal obstruction, pulmonary infection in 1 case, all patients with postoperative complications cured by conservative treatment. ⑤ Toxicities: Hemoglobin decreased in 9 patients, leukopenia in 14 patients, decreased platelet in 8 patients, elevated ALT in 5 patients and elevated AST in 6 patients. Nineteen patients developed nausea. Ten patients had numbness and other neurotoxic side effects, after treatment, ease. ⑥ Follow-up results: As of November 2015, patients were followed up for 4 to 39 months. One patient died of cachexia due to extensive abdominal metastasis. One patient developed multiple liver metastases and died of liver failure, and one patient had brain metastases One patient died of other illnesses and the remaining 20 patients survived. Follow-up no incision and poke hole implant transfer occurred. Conclusion Based on the limited data in this group, FLEEOX neoadjuvant chemotherapy combined with laparoscopy in the treatment of locally advanced gastric cancer is safe and effective, with less trauma and faster postoperative recovery.