局部进展期胃癌的综合治疗策略

Comprehensive treatment stategies of locally advanced gastric cancer

胃癌是常见的消化系统恶性肿瘤之一,目前外科手术仍然是治疗进展期胃癌的主要手段,进展期胃癌行D2淋巴结清扫术已逐渐达成共识。在D2淋巴结清扫术的基础上,由经验丰富的外科医师完成腹腔镜远端胃癌根治术的安全性和肿瘤学疗效均不劣于开腹手术,且腹腔镜保脾脾门淋巴结清扫术安全可行。辅助化疗和新辅助化疗可以延长胃癌患者术后生存时间,常见化疗方案有单药S-1、XELOX方案或S-1联合多西他赛。DOS方案、SOX方案和FLOT方案是常用的新辅助化疗方案。分子靶向药物或免疫药物尚未被批准用于局部进展期胃癌围手术期一线治疗,但越来越多的研究结果提示联合分子靶向治疗或免疫治疗,可以有效提高新辅助治疗后进展期胃癌的R_(0)切除率或病理学完全缓解率,能否延长患者生存时间等尚无证据支持。针对进展期胃癌最佳的综合治疗方案,尚无统一标准,需要深入研究。

Gastric cancer is one of the most common malignant tumors in the digestive system.At present,surgery is still the main treatment for gastric cancer and the consensus has been reached that D2 lymph node dissection should be performed for advanced gastric cancer.Laparoscopic distal gastrectomy for locally advanced gastric cancer completed by experienced surgeons was comparable to open surgery in terms of safety and oncology.Laparoscopic spleen preserving splenic hilar lymph node dissection is safety and effective.Adjuvant chemotherapy and neoadjuvant chemotherapy can prolong postoperative survival time of gastric cancer patients.The common chemotherapy regimens are single drug S-1,XELOX regimen or S-1 combined with docetaxel.DOS regimen,SOX regimen and FLOT regimen are commonly used neoadjuvant chemotherapy regimens.Molecular targeted drugs or immunotherapeutic drugs has not been approved for the perioperative first-line treatment of locally advanced gastric cancer,but more and more clinical research results suggest that the combination of targeted therapy or immunotherapy can improve the R_(0) rate or pathological complete response rate.There is no evidence to support that combination treatment can prolong survival time.The best comprehensive treatment for advanced gastric cancer is not unified,which needs further researches.