进展期胃癌新辅助化疗后手术时机的选择

Timing of surgery after neoadjuvant chemotherapy for advanced gastric cancer

进展期胃癌的同手术期化疗、尤其新辅助化疗（NAC）的效果备受瞩目。美国、英国和日本开展的诸多NAC试验结果显示．NAC能够使肿瘤和转移淋巴结缩小．降低T分期和N分期，使不能切除的肿瘤在NAC后实现R0切除，具有良好的改善生存的效果。由于NAC及其方案对不同个体的影响不同，手术时机、手术方案及治疗目标也有所不同。选择低毒、无不良反应及不增加手术风险的NAC方案同然重要，但在充分熟悉了解药物的药理和药代动力学及对人体组织细胞学影响的基础上．对于NAC后的外科手术应谨慎选择和严格质控。

Several studies have demonstrated the benefit of perioperative chemotherapy in the treatment of advanced gastric cancers, especially the neoadjuvant chemotherapy （NAC）. Many NAC trials in the United States, UK and Japan have proved that NAC can shrink the tumor and metastatic lymph nodes, downstage the T and N staging, achieve more curative （R0） resection for the unresectable cases, and even improve survival. Various neoadjuvant chemotherapy regimens have different effects on the body, therefore the timing selection of surgery, surgical programs and goals are different accordingly. Optimal surgery after neoadjuvant chemotherapy should be based on full comprehension of the pharmacology and pharmacokinetics. Strict surgical quality control is necessary.