胃癌综合治疗的现状与展望

Multidisciplinary Management of Gastric Cancer:Present and Future Status

几年来胃癌的手术治疗和辅助治疗方法及策略取得了一些进展。作为标准术式的D2根治手术及扩大根治术并非适用于所有的胃癌病例,应根据分期调整治疗策略。早期胃癌可以通过内镜下切除或经腹腔镜手术治疗,一些神经保护技术也可用于早期胃癌治疗。胃癌的联合脏器切除和扩大切除一直存在争议。对于局部进展期胃癌,术前化疗或放化疗可以提高切除率,术后的化疗或放化疗则带来生存获益。随着靶向药物的出现,靶向药物联合化疗有可能成为进展期胃癌标准的治疗方案。对于腹腔种植转移的进展期胃癌,减瘤手术联合腹腔化疗已经成为治疗的选择之一。

Over the past few years, progress has been made in surgery and adjuvant therapy in treating gastric cancer. As the standard mode of surgery, the D2 or extended radical surgery does not apply to all cases of gastric cancer. Thus, a tailored approach depending on the stage of the disease is needed. Early gastric cancer may benefit from resection by endoscopic or laparoscopic techniques and may also be suitable for function-preserving procedures. The multi-visceral resections and extended excision for gastric cancer has always been controversial. The preoperative treatment of locally advanced tumors increases the resectability of the tumors. Postoperative chemo-radiation or chemotherapy in gastric adeno-carcinomas showed increased rates of survival among patients with gastric cancer. With the introduction of brand-new targeted agents combined with conventional chemotherapy, multi-mode therapeutic regimens are likely to emerge as global standards for advanced gastric carcinoma treatment. The cytoreductive surgery combined with peri-operative intra-peritoneal chemotherapy has been recommended as a kind of therapy for treating patients with peritoneal carcinomatosis.