In Reply We appreciate the thoughtful responses from Rosa and Alfieri to our article on the safety of laparoscopic gastrectomy after neoadjuvant chemotherapy in a pilot randomized clinical trial (RCT).1 Preoperative chemotherapy and laparoscopic surgery for advanced gastric cancer have been a research hotspot for nearly 20 years. However, high-quality evidence on efficacy and safety of laparoscopic gastrectomy in patients with neoadjuvant chemotherapy is absent, which drove us to conduct this single-center pilot RCT. We estimated the sample size based on primary outcome (3-year recurrence free survival)2 and recruited the required number of eligible patients in 31 months. We agree with Rosa and Alfieri: to draw a solid conclusion on efficacy and safety of laparoscopic distal gastrectomy followed up with neoadjuvant chemotherapy, a large-scale, multicenter trial is indispensable. This recruitment data with other results from this pilot study can provide useful information to develop a future definitive RCT.
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Shan F, Li Z, Ji J. Laparoscopic Gastrectomy After Neoadjuvant Chemotherapy—Reply. JAMA Surg. 2020;155(5):450–451. doi:10.1001/jamasurg.2019.5946
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