AUTHOR=Su Jin , Guo Weihong , Chen Zhian , Wang Lingzhi , Liu Hao , Zhao Liying , Lin Tian , Li Fengping , Mao Xinyuan , Huang Huilin , Yu Jiang , Li Guoxin , Hu Yanfeng 

TITLE=Safety and short-term outcomes of laparoscopic surgery for advanced gastric cancer after neoadjuvant immunotherapy: A retrospective cohort study

JOURNAL=Frontiers in Immunology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2022.1078196

DOI=10.3389/fimmu.2022.1078196

ISSN=1664-3224

ABSTRACT=<sec><title>Background</title><p>Immune checkpoint inhibitors (ICIs) have been increasingly used for the treatment of advanced gastric cancer (AGC). However, the safety and the short-term outcomes of laparoscopic gastrectomy for patients with AGC after neoadjuvant immunotherapy (NAI) remain unknown.</p></sec><sec><title>Methods</title><p>We retrospectively analyzed the patients with AGC who underwent laparoscopic surgery after neoadjuvant therapy between 1 January 2019 and 31 October 2021. We further compared the differences in postoperative complications, overall response rate, adverse events, surgical parameters, and postoperative recovery between two cohorts: the NAI group (NAI plus chemotherapy) and the neoadjuvant chemotherapy (NAC) group. Multivariable regression analyses were used to determine the risk factors for the overall response rate.</p></sec><sec><title>Results</title><p>Overall, 80 patients were enrolled, of whom 30 cases were included in the NAI cohort and 50 were included in the NAC cohort. The overall rate of postoperative complications was 30.0% in both groups (<italic>p =</italic> 1.000). The overall response rate was 70.0% in the NAI cohort and 40% in the NAC cohort (<italic>p =</italic> 0.012). The adverse effects were found in 16 cases (53.3%) of the NAI cohort and 23 cases (46.0%) of the NAC cohort (<italic>p =</italic> 0.645). There was no statistical difference in intraoperative bleeding (50 ml vs. 50 ml, <italic>p =</italic> 0.983), operation time (320.9 min vs. 303.5 min, <italic>p =</italic> 0.382), dissected lymph node count (43.5 vs. 40.0, <italic>p =</italic> 0.364), first postoperative anal aerofluxus (3 days vs. 3 days, <italic>p =</italic> 0.091), first liquid diet (4 days vs. 5 days, <italic>p =</italic> 0.213), and postoperative length of stay in the hospital (8 days vs. 7 days, <italic>p =</italic> 0.508) between the two groups. NAI was estimated to be the independent protective factor [odds ratio (OR) 4.931, 95% confidence interval (CI) (1.385–17.559), <italic>p =</italic> 0.014] for odds to overall response rate, whereas vessel invasion was found to be the significant risk factor [OR 0.113, 95% CI (0.027–0.475), <italic>p =</italic> 0.003].</p></sec><sec><title>Conclusions</title><p>Laparoscopic surgery after NAI combined with chemotherapy is a safe therapeutic choice for AGC and may bring better short-term outcomes due to a higher overall response rate.</p></sec>