从规范化到精准化：胃癌手术治疗的发展

From standard to precision treatment： the development of surgery for gastric cancer

胃癌全球发病率居恶性肿瘤第5位,死亡率居第3位,严重威胁人类健康.近几十年来,胃癌的手术治疗模式发生了很大变化：推荐进展期胃癌进行D2淋巴结清扫;胃癌根治手术无需进行预防性胰腺和脾脏的联合器官切除;以腹腔镜手术为代表的微创治疗的适应证目前仅为早期胃下部癌;只有早期胃癌可以进行缩小手术,其中前哨淋巴结的应用是缩小手术范围的有效手段.同时,随着胃癌分子生物学技术的发展,我们从分子层面上对胃癌的分子分型有了新的了解,胃癌即将进入精准医疗的时代.

Gastric cancer remains a significant health problem worldwide.The incidence of gastric cancer is the 5th of all the malignancies,and the mortality is the 3rd.The type and resection area of gastric cancer surgery have changed a lot.D2 lymph node dissection is recommended for locally advanced gastric cancer.Prophylactic pancreatectomy or splenectomy is not necessary for radical resection.Indication of minimally invasive surgery is confined to early gastric cancer with distal gastrectomy.Less extensive approach of early stage cases is suitable,and application of sentinel lymph node is a potential method.Meanwhile,the development of chemotherapy,radiotherapy,targeted therapy and immunotherapy during the perioperative period also improved the prognosis of gastric cancer patients.Recently,the development of molecular biology,such as the maturity of the new generation sequencing approach,started a new era of precision treatment for gastric cancer.