免疫治疗背景下对胃肠道肿瘤区域淋巴结清扫的再认识

Re-understanding of Regional Lymph Node Dissection forGastrointestinal Tumors in the Context of Immunotherapy

胃肠道肿瘤手术传统的理念为D1~D2淋巴结清扫,有时扩大到D3淋巴结清扫范围以达到清除肿瘤的目的。随着免疫治疗在胃肠道肿瘤中不断取得突破,逐渐发现区域淋巴结是T淋巴细胞成熟与发挥免疫作用的场所,也是T淋巴细胞的输出场所。区域淋巴结在免疫治疗中也起着重要的作用,免疫治疗可以通过激活区域淋巴结中的免疫细胞,增强免疫系统的功能,从而对抗癌细胞。最近研究发现,在免疫治疗结束前保持淋巴结完整,可以提高免疫治疗在实体瘤的疗效。因此,精准清除有转移的淋巴结,保留有免疫作用的淋巴结,是提高免疫治疗效果的关键。因此,基于免疫治疗的背景,再认识区域淋巴结清扫在胃肠道肿瘤手术以及免疫治疗中的意义,将为胃肠道肿瘤术中精准淋巴结清扫和综合治疗提供的新方向。

The traditional concept of gastrointestinal tumor surgery is based on the principle of D1~D2,or expanding to D3 lymph node dissection to achieve complete tumor removal.With the breakthrough of immunotherapy in gastrointestinal tumors,it has been revealed that regional lymph nodes are the place where T lymphocytes mature and are exported from,which may play an important role in immunotherapy.Recent studies have found that keeping lymph nodes intact until the end of immunotherapy can improve the efficacy of immunotherapy in solid tumors.Therefore,precise removal of metastatic lymph nodes and preserving immune lymph nodes are beneficial to immunotherapy.Re-understanding the implication of regional lymph node dissection in the context of immunotherapy will provide a new direction for precise lymph node dissection and comprehensive treatment in gastrointestinal tumor surgery.