新辅助化疗对腹腔镜辅助胃癌根治术后吻合口并发症及远期预后的影响

Influence of Neoadjuvant Chemotherapy on Anastomotic Complications and Long-Term Prognosis after Laparoscopic Radical Gastric Cancer Surgery

摘要: 目的：分析新辅助化疗对腹腔镜辅助胃癌根治术后吻合口并发症的发生及吻合口并发症对远期预后的影响。方法：回顾性分析2010年1月至2020年1月在青岛大学附属烟台毓璜顶医院行腹腔镜辅助胃癌根治术的1199例胃癌患者的临床病理资料及术后吻合口并发症发生情况，包括吻合口漏、吻合口狭窄和吻合口出血。根据患者是否接受过新辅助化疗将其分为新辅助化疗组(170例)和非新辅助化疗组(1029例)。分析术前新辅助化疗与腹腔镜辅助胃癌根治术后吻合口并发症发生率的关系及吻合口并发症对胃癌预后的影响，并使用倾向性评分匹配(PSM)消除两组的潜在混淆偏差后，比较两组吻合口并发症发生率的差异及吻合口并发症与远期预后的关系。结果：PSM之前，新辅助化疗组和非新辅助化疗组的吻合口并发症的发生率，包括吻合口漏、吻合口狭窄和吻合口出血，均没有明显差异(P > 0.05)。PSM之后，新辅助化疗组和非新辅助化疗组的吻合口并发症的发生率，包括吻合口漏、吻合口狭窄和吻合口出血，均没有明显差异(P > 0.05)。二分类Logistic回归分析显示，贫血、肺炎是腹腔镜辅助胃癌根治术后吻合口漏的独立危险因素(P < 0.05)，新辅助化疗并不是术后吻合口漏的独立危险因素(P > 0.05)。根据有无吻合口并发症，将1199名患者分为2组，构建生存曲线并进行生存分析，结果发现无吻合口并发症患者较吻合口并发症患者的5年生存率更好(2.326 (1.570~3.448), P < 0.001)。结论：新辅助化疗对腹腔镜辅助胃癌根治术后吻合口并发症的发生率没有明显影响，发生吻合口并发症的患者预后不良。

Abstract: Objective: To analyze the occurrence of neoadjuvant chemotherapy on anastomotic complications after laparoscope-assisted radical gastric cancer surgery and the influence of anastomotic complica-tions on the long-term prognosis. Methods: The clinical and pathological data of 1199 patients with gastric cancer who underwent laparoscope-assisted radical gastrectomy in Yantai Yuhuangding Hospital Affiliated to Qingdao University from January 2010 to January 2020 were retrospectively analyzed, including anastomotic leakage, anastomotic stenosis and anastomotic bleeding. According to whether the patients had received neoadjuvant chemotherapy, they were divided into neoadju-vant chemotherapy group (170 cases) and non-neoadjuvant chemotherapy group (1029 cases). Ob-jective: To analyze the relationship between preoperative neoadjuvant chemotherapy and the inci-dence of anastomotic complications after laparoscope-assisted radical gastrectomy and the impact of anastomotic complications on the prognosis of gastric cancer. After eliminating the potential confusion bias between the two groups by propensity score matching (PSM), the difference of inci-dence of anastomotic complications between the two groups and the relationship between anasto-motic complications and long-term prognosis were compared. Results: Before PSM, there was no significant difference in the incidence of anastomotic complications, including anastomotic leakage, anastomotic stenosis and anastomotic bleeding between neoadjuvant chemotherapy group and non-neoadjuvant chemotherapy group (P > 0.05). After PSM, there was no significant difference in the incidence of anastomotic complications either, including anastomotic leakage, anastomotic ste-nosis and anastomotic bleeding between neoadjuvant chemotherapy group and non-neoadjuvant chemotherapy group (P > 0.05). Binary logistic regression analysis showed that anemia andpneumonia were independent risk factors for anastomotic leakage after radical gastrectomy (P < 0.05), and neoadjuvant chemotherapy was not independent risk factor for anastomotic leakage after radical gastrectomy (P > 0.05). According to whether there were anastomotic complications, 1199 patients were divided into two groups. The survival curve was constructed, and the survival analysis was carried out. The results showed that the 5-year survival rate of patients without anas-tomotic complications was better than that of patients with anastomotic complications (2.326 (1.570~3.448), P < 0.001). Conclusion: Neoadjuvant chemotherapy has no significant effect on the incidence of anastomotic complications after laparoscope-assisted radical gastric cancer surgery, and the prognosis of patients with anastomotic complications is poor.