新辅助治疗对腹腔镜胃癌根治术病人围手术期并发症的影响

Effect of neoadjuvant therapy on perioperative complications in patients undergoing laparoscopic radical gastrectomy

我国是胃癌大国,且以进展期为主,超过一半病人在确诊时已是局部进展期胃癌。过去20年,局部进展期胃癌的治疗最重要的进展主要在两方面,一方面是治疗模式的变革,从单纯手术到以手术为主的围手术期综合治疗,而另一方面则是手术方式的进步,从传统的开腹手术转变成以腹腔镜手术为主的微创治疗。两者的有机结合是胃癌外科的进步,但同时也带来新的临床问题,新辅助治疗后引起的水肿和纤维化等组织改变是否影响手术安全性,以及新辅助治疗后的腹腔镜手术与开腹手术相比是否影响手术安全性,成为外科关注的热点。围绕这两议题,该文系统梳理相关研究,并结合作者单位的研究与实践,浅析新辅助治疗对腹腔镜胃癌根治术病人围手术期并发症的影响。

Gastric cancer(GC)is a prevalent malignancy in China.Upon a definite diagnosis,more than half of GC patients developed locally advanced disease.Over the past two decades,significant advancements have been achieved for locally advanced GC.On one hand,surgery with perioperative therapies,instead of surgery alone,has become a mainstay of locally advanced GC.On the other hand,with the refining of laparoscopic techniques,laparoscopy may replace conventional open surgery as a viable alternative.However,such issue changes caused by neoadjuvant therapy as edema and fibrosis could affect the safety and efficacy of gastrectomy.Also the safety and efficacy of laparoscopic versus open gastrectomy after neoadjuvant therapy remain inconclusive.This review summarized the latest studies and gained valuable insights from our institutional researches and experiences to explore the impact of neoadjuvant therapy on laparoscopic gastrectomy.