Safety and short-term efficacy of gastrectomy after preoperative chemotherapy plus immunotherapy versus preoperative chemotherapy: A retrospective cohort study

Abstract Purpose This study was conducted to compare the safety and short-term efficacy of gastrectomy after preoperative chemotherapy plus immunotherapy (PCIT) versus preoperative chemotherapy (PCT) in patients with advanced gastric cancer (AGC).Methods We retrospectively reviewed the data of patients with AGC who received PCIT or PCT at Peking University Cancer Hospital and Institute Gastrointestinal Cancer Center I between January 2019 and June 2021. The clinical characteristics were recorded, and short-term oncological outcomes were compared. Independent t-tests, Mann-Whitney U tests, Chi-square tests, and Fisher’s exact tests were used to calculate differences. The correlation analyses were performed using Pearson correlation. All p values were two-sided, and a p-value <0.05 was considered as statistically significant. All the above statistical analyses were conducted by the SPSS version 24.0 software package (IBM Corp., Armonk, NY, USA).Results A total of 162 AGC patients were included in this study, including 25 patients receiving PCIT and 137 patients receiving PCT. There were no significant differences in preoperative treatment-related adverse events (TRAEs) between the PCIT group and the PCT group (p=0.088). Compared with the PCT group, the PCIT group had comparable postoperative functional recovery, with no significant differences in terms of the first aerofluxus time (p=0.349), the first defecating time (p=0.800), the first time on liquid diets (p=0.233), and length of stay (p=0.278). No significant differences were observed in terms of postoperative complications (p=0.952), postoperative pain intensity at 24, 48, and 72 hours (p=0.375, p=0.601, and p=0.821, respectively), and postoperative supplementary analgesic between the two groups (p=0.881). In addition, the postoperative complication rates were 33.3% following the laparoscopic approaches and 31.2% following the open approaches in the PCIT group, with no significant difference (p=1.000).Conclusions In patients with AGC, gastrectomy with D2 or D2+ lymphadenectomy after PCIT was comparable to PCT in terms of short-term oncological outcomes. The safety of LG was similar to that of OG in patients with AGC after PCIT.