Impacto dos Inibidores de Checkpoint Imunológico Perioperatórios na Viabilidade Cirúrgica e nos Desfechos Pós-operatórios em Adenocarcinoma Ressecável de Estômago e da Junção Gastroesofágica: Revisão Sistemática e Meta-análise de Ensaios Clínicos Randomiz

Abstract

Immune checkpoint inhibitors have emerged as animportant complementary strategy in the treatment of varioustypes of cancer. However, uncertainties remain regarding theimpact of their combination with perioperative chemotherapyon surgical feasibility and postoperative outcomes in patientswith resectable gastric and gastroesophageal junctionadenocarcinoma. To address this issue, a systematic review and meta-analysis of randomized controlled trials wereconducted comparing perioperative immunotherapy plus chemotherapy with chemotherapy alone. The resultsdemonstrated that the addition of immune checkpoint inhibitors significantly improved pathological response, indicating enhanced antitumor efficacy. Conversely, no relevant differences were observed between treatment groupsregarding surgical completion, surgical complications, complete tumor resection, or the incidence of severe adverse events, suggesting that the incorporation of immunotherapydoes not compromise surgical safety or feasibility. Nevertheless, patients receiving immunotherapy experiencedhigher rates of treatment discontinuation, highlighting theimportance of careful toxicity monitoring and appropriatepatient selection. Overall, these findings suggest that theperioperative use of immune checkpoint inhibitors representsa promising therapeutic approach for resectable gastric andgastroesophageal junction adenocarcinoma, providingimproved pathological responses without adversely affectingsurgical safety.