胃癌伴有腹主动脉旁淋巴结转移的术前新辅助化疗

Neoadjuvant chemotherapy before surgery for adbominal paraaortic lymph node metastasis in gastric cancer

淋巴结转移是胃癌转移和复发的主要途径,也是胃癌患者预后极其重要的影响因素。关于胃癌淋巴结的清扫范围,D2淋巴结清扫在全球范围内被推荐为标准胃癌术式。目前,预防性No. 16淋巴结清扫的临床意义已被否定,治疗性No. 16淋巴结清扫目前仍有争议。在没有其他远处部位转移的前提下,局限于No. 16a2/b1淋巴结且排除其他无法根治因素时,推荐做新辅助化疗+D2淋巴结清扫+腹主动脉旁淋巴结清扫(PAND)。新辅助化疗可以使肿瘤降期,增加R0手术机会,对于新辅助化疗方案,目前推荐使用SP方案—替吉奥(S-1)联合顺铂(CDDP)。

Lymph node metastasis is the main pathway for gastric cancer metastasis and recurrence,and is an important factor affecting the prognosis of gastric cancer patients. D2 lymph node dissection is recommended as a standard gastric cancer surgery worldwide for lymph node dissection of gastric cancer. The clinical significance of No. 16 lymph node dissection has been denied,and the treatment of No. 16 lymph node dissection is still controversial. In the absence of other distant site metastases,being limited to No. 16 a2 and No. 16 b1 lymph nodes and excluding other incurable factors,it is recommended to receive neoadjuvant chemotherapy ＋ D2 lymph node dissection ＋ PAND（ abdominal para-aortic lymph node dissection）. Neoadjuvant chemotherapy can reduce the degree of tumor and increase the chance of R0 operation. In the neoadjuvant chemotherapy program,the SP program,including sinoplatin（ S-1） combined with sinoplatin（ CDDP）,is recommended.