腹腔镜胃癌手术不应忽视肿瘤治疗的原则

Never ignore the therapeutic principles during the procedure of laparoscopic gastrectomy for gastric cancer

自1994年Kitano报道首例腹腔镜辅助远端胃切除联合淋巴结清扫手术以来．近年在日本和韩国，腹腔镜手术已被广泛应用于淋巴结转移风险低的早期胃癌。腹腔镜胃癌手术的目的在于最大限度地减少手术创伤，提高患者生活质量，但要以保证手术的根治性为前提。随着腹腔镜手术经验的不断积累，目前腹腔镜胃切除术的指征已逐渐从早期胃癌扩大到进展期胃癌。但是由于缺乏长期疗效的循证医学证据支持，腹腔镜手术在进展期胃癌中的运用尚存争议。因此，为保证腹腔镜胃癌手术获得与传统开腹手术相似的临床疗效，必须严格遵循肿瘤治疗的基本原则．诸如合适的病例选择，充分的手术切缘．规范的D2淋巴结清扫及符合无瘤原则等。

In recent years, minimally invasive surgery has been adopted and widely used in Japan and Korea for earl）＇ gastric cancer with low risk of lymph node metastasis, since laparoseopy-assisted distal gastrectomy（LADG） with lymph node dissection was first reported in 1994 by Kitano. Thepurposes of laparoscopic surge for gastric cancer are to minimize surgical insults and to maximize patient＇s quality of life, while not compromising the oncologic clearance. As laparoscopic experience has accumulated, the indications for laparoscopic gastrectomy（LG） have been broadened to patients with advanced gastric cancer. However, the role of LG remains controversial, because studies of the long-term outcomes of LG are insufficient. Therefore, in order to make sure the same effectiveness of LG as conventional open operation, there are some basic principles should be strictly followed while performing LG, such as properly selected patients, sufficient surgical margins, standardized D2 lymphadenectomy, no-touch technique and so on.