从中国CLASS-03a研究的开展看腹腔镜手术联合新辅助化疗的胃癌治疗

Laparoscopic gastrectomy combined with neoadjuvant chemotherapy for gastric cancer patients： from the view of the CLASS-03a trial

新辅助化疗联合手术治疗是目前进展期胃癌综合治疗的重要组成部分之一。随着近年来腹腔镜技术的发展，腹腔镜技术在胃癌外科中也占据着越来越重要的地位。虽然新辅助化疗作为胃癌临床综合治疗的一部分，已经得到越来越多的临床证据支持及指南推荐；且随着近年来胃癌腹腔镜外科的发展，在陆续涌现的临床证据支持下，进展期胃癌腹腔镜手术的开展也越来越广泛。然而，新辅助化疗后行腹腔镜手术切除，作为一种全新的治疗策略，其安全性及有效性仍有待前瞻性高级别研究对其进行验证。因此，基于中国腹腔镜胃肠外科研究组（CLASS研究组）的平台，由四川大学华西医院胃肠外科牵头，北京肿瘤医院作为共同PI单位负责的＂局部进展期胃癌新辅助化疗后腹腔镜远端胃癌D2根治术的可行性与安全性分析：前瞻性多中心临床试验（CLASS 03a）＂应运而生。该研究拟以局部进展期胃下部腺癌（cT3~4a、N-/＋、M0）病例为研究对象，评估在新辅助化疗后实施腹腔镜远端胃癌D2根治术的可行性、手术安全性及外科肿瘤学安全性。本文在结合CLASS 03a临床研究开展的基础上，论述了胃癌新辅助化疗方案的选择，在综述新辅助化疗后腹腔镜手术研究现状的同时，提出了新辅助化疗联合腹腔镜胃癌手术的相关问题。

Neoadjuvant chemotherapy combined with radical gastrectomy is one of the most important parts of the multimodality therapy strategies for locally advanced gastric cancer. With the development of laparoscopic technique in recent decades, laparoscopic technique plays a more and more important role in the surgical treatment of gastric cancer. Neoadjuvant chemotherapy, as a part of comprehensive treatment of gastric cancer, has gained more and more clinical supports and been recommended for guidelines. With the development of laparoscopic technique and clinical evidence, laparoscopic operation for advanced gastric cancer has been applied more and more widely. However, the safety and efficacy of laparoscopic resection following neoadjuvant chemotherapy, as a new treatment modality, still needs prospectively high-level researches to verify. Therefore, we will discuss some key points of laparoscopic gastrectomy after neoadjuvant chemotherapy based on the CLASS 03a trial, which is led by the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, the Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, and Chinese Laparoscopic Gastric Surgery Study Group. The CLASS 03a trial aims to confirm surgical and oncological safety of laparoscopy distal D2 radical gastrectomy for locally advanced stage gastric cancer patients （cT3~4a, N-/＋, M0） who completed neoadjuvant chemotherapy. On the base of CLASS 03a trial, this article elucidates the choice of neoadjuvant chemotherapy for gastric cancer and proposes some associated problems about neoadjuvant chemotherapy combined with laparoscopic gastric cancer operation.