Treatment of Locally Advanced Gastric Cancer with the XELOX Program of Neoadjuvant Chemotherapy Combined with Laparoscopic Surgery: The Experience in China

Background/Aims: Although the XELOX regimen has been recommended as first-line adjuvant chemotherapy for advanced gastric cancer (AGC), its role in neo-adjuvant setting is not well established. Therefore, we aimed to assess the clinical effect of XELOX neoadjuvant chemotherapy on AGC when combined with laparoscopic surgery. Methodology: We compared the effects of perioperative XELOX (neoadjuvant chemotherapy group, NCG) with the effects of adjuvant XELOX (direct surgical group, DSG) in patients with locally AGC. The response to chemotherapy was assessed according to Recist criteria and pathological changes. The KaplanMeier log-rank test was used to calculate and compare survival differences. Results: Seventy patients were included (neoadjuvant=35). The rate of effective neoadjiuvant chemotherapy was 62.9%, and the disease control rate was 91.5%. In the NCG, 32 (94.7%) of the patients underwent laparoscopic-assisted D2 radical gastrectomy. The RU resection rate was 100%. However, rates were 26 (74.3%) and 85.7% in the DSG, respectively (P<0.05). The 3-year overall survival (OS) in the NCG was 77.1% vs. 62.3% in the DSG (P=0.119). The 3-year disease-free survival (DFS) was 74.3% in the NCG, and the DFS was 59.3% in the DSG (P=0.033). Conclusions: XELOX can enhance the RO resection rate, increase potential for laparoscopic surgery with rather good safety and improve the 3-year DFS of patients with AGC.