胃癌新辅助治疗后行腹腔镜手术争议与共识

Laparoscopic gastrectomy for locally advanced gastric cancer after neoadjuvant chemotherapy:consensus and controversies

外科手术联合围手术期治疗是进展期胃癌治疗的主要手段。随着新辅助治疗的深入研究和腹腔镜技术的发展,腹腔镜手术在接受新辅助治疗后的进展期胃癌病人中的应用也逐渐成为胃癌治疗领域的研究热点。该治疗模式的关注点主要在于病例选择、围手术期获益、远期预后等问题上。最新研究结果表明,胃癌新辅助治疗后行腹腔镜手术的安全性已获得初步验证,但该治疗模式能否为进展期胃癌病人带来长期生存获益仍缺乏高级别循证医学证据。此外,该治疗模式在病例选择的合理性问题上需尤为谨慎,如对于合并融合淋巴结,BorrmannⅣ型和大Ⅲ型等类型胃癌病人应进行全面评估、谨慎决策。再者,如何实现新辅助治疗后胃癌腹腔镜手术操作规范和落实腹腔镜手术资质认定是施行该项技术拟解决的关键问题。因此,仍需开展更多大样本前瞻性临床研究对该领域的热点问题进行深入探索。

Surgical resection combined with perioperative treatment is the main treatment strategy for patients with advanced gastric cancer(AGC).With the further exploration of neoadjuvant chemotherapy and the development of laparoscopic technology,the performance of laparoscopic surgery after receiving neoadjuvant chemotherapy in AGC patients has gradually become the hot topic for gastric cancer treatment.The main controversies of this treatment strategy include the issues of patient selection,perioperative benefits,and long-term prognosis,etc.Previous studies have demonstrated the safety and feasibility of laparoscopic gastrectomy after neoadjuvant chemotherapy.However,there is still a lack of strong evidence for the long-term benefits of this treatment model.The rationality of case selection should be highlighted.For example,comprehensive evaluations should be conducted for patients,such as those with bulky lymph nodes,Borrmann typeⅣ,or large typeⅢgastric cancer.Furthermore,how to standardize the operational process and implement the qualification of laparoscopic surgery remain crucial issues for implementing this treatment strategy.Therefore,more prospective clinical studies with larger sample sizes are needed to address the concerns in this field.