从LOC-A研究看腹腔镜手术治疗进展期胃癌的可行性及其疗效

Feasibility and efficacy of laparoscopic treatment for advanced gastric cancer from LOC-A study

随着手术技术、腹腔镜设备以及治疗理念的不断进步，腹腔镜胃癌根治术在临床得到了广泛应用，而腹腔镜能否用于局部进展期胃癌的治疗尚存在争议。韩国KLASS-02研究、日本JCOG-0901研究以及中国的CLASS-01研究的近期结果均提示，腹腔镜手术与开放手术在治疗局部进展期胃癌的近期疗效上无明显差异，而远期结果尚未公布。LOC-A研究为木下敬弘团队在多中心、大样本量的基础上回顾性分析2008—2014年间日本8家医院的1948例腹腔镜与开放胃癌手术治疗Ⅱ~Ⅲ期局部进展期胃癌疗效的研究结果，在经过倾向评分匹配（PSM）处理去除混杂因素后，分析显示，对于局部进展期胃癌，腹腔镜手术和开放手术在远期疗效上无明显差异；但作为回顾性研究无可避免的存在一些偏倚。因此，基于高级别循证医学证据尚不充分，本文认为目前全面推广腹腔镜应用于局部进展期胃癌还为时过早，但我们也应该认识到胃癌的微创化治疗是当今的发展趋势，应对局部进展期胃癌的腹腔镜治疗充满信心。

With the progression of surgical techniques, laparoscopic equipment and treatment concepts, laparoscopic radical gastrectomy has been widely used in clinical practice. However, whether laparoscopic surgery can be used for the treatment of locally advanced gastric cancer is still controversial. Recent results from the Korean KLASS-02 study, the Japanese JCOG-0901 study, and the Chinese CLASS-01 study suggest that there is no significant difference in the short-term efficacy between laparoscopic surgery and open surgery in the treatment of locally advanced gastric cancer. The long-term results have not been published. The LOC-A study was a multicenter, large sample size retrospective analysis that enrolled 1948 laparoscopic and open surgery cases with stage II to III locally advanced gastric cancer in 8 Japanese hospitals between 2008 and 2014. As a result, after removal of confounding factors by propensity score matching （PSM） , the analysis showed no significant difference in long-term efficacy between laparoscopic surgery and open surgery for locally advanced gastric cancer. However, some bias still remain after the bias-control. Therefore, due to insufficiency of the high-level evidence-based medical evidence, we believe that the all-round promotion of laparoscopic surgery of locally advanced gastric cancer is too early, nevertheless, we should also recognize that the minimally invasive treatment of gastric cancer is the current development trend, and we should be confident in laparoscopic treatment of locally advanced gastric cancer.