腹腔镜进展期胃癌D2根治术的研究进展

Research Progress of Laparoscopic D2 Radical Gastrectomy for Advanced Gastric Cancer

腹腔镜治疗早期胃癌已经得到JGCA、CSCO等临床指南的证实和推广。目前的争论主要在于进展期胃癌,特别是浆膜受侵犯胃癌病例的腹腔镜手术。进展期胃癌通常伴有周围组织的浸润和淋巴结的侵犯。手术治疗不仅需要切除胃癌肿瘤,还需要对周围组织和淋巴结进行扩大清扫,技术难度较大。1997年,Goh等人首次采用腹腔镜手术治疗4例进展期胃癌患者,取得了不错的效果,初步证明了腹腔镜手术治疗进展期胃癌的可行性和安全性。随着日本、韩国和中国多项前瞻性、多中心、高质量、随机对照试验的完成,腹腔镜手术治疗进展期胃癌的安全性和有效性得到进一步验证。然而,腹腔镜在进展期尤其是浆膜受侵犯的胃癌中的实际应用在不同国家和地区仍存在很大的争议。

Laparoscopic treatment of early gastric cancer has been confirmed and promoted by JGCA, CSCO and other clinical guidelines. The current debate is mainly about laparoscopic surgery for advanced gastric cancer, especially in patients with serosa invasion. Advanced gastric cancer is usually accompanied by infiltration of surrounding tissue and lymph node invasion. Surgical treatment requires not only resection of gastric cancer, but also enlarged dissection of surrounding tissues and lymph nodes, which is technically difficult. In 1997, Goh et al. used laparoscopic surgery for the first time to treat 4 patients with advanced gastric cancer, and achieved good results, which preliminarily proved the feasibility and safety of laparoscopic surgery in the treatment of advanced gastric cancer. With the completion of a number of prospective, multicenter, high-quality, randomized controlled trials in Japan, South Korea and China, the safety and effectiveness of laparoscopic surgery in the treatment of advanced gastric cancer has been further verified. However, the practical application of laparoscopy in advanced gastric cancer, especially in serosa invaded gastric cancer, is still controversial in different countries and regions.