Perioperative Chemotherapy versus Adjuvant Chemotherapy in Patients with Resectable Gastric Cancer: A Systematic Review with meta-analysis

The study aimed to investigate the prognosis and safety of perioperative chemotherapy (PC) compared with adjuvant chemotherapy (AC). We systematically searched and assessed studies in PubMed, Embase, and the Cochrane Library from inception to 1st September 2022. Eighteen studies were eligible for the analysis, including 4686 patients in total. Our study found that patients with resectable gastric cancer undergoing PC had favorable prognosis on OS (HR 0.77; 95% CI 0.69 to 0.87) and DFS (HR 0.76; 95% CI 0.69 to 0.84) than those who undergoing AC. Addition of neoadjuvant chemotherapy (NAC) to AC provided higher R0 resection rate but did not increase the risk of postoperative complication rate and most of the adverse event rates. Our study demonstrated that PC shows better OS and DFS in Asians with resectable gastric cancer compared with AC. PC should be preferred because of its favorable prognosis and similar safety.