Subtotal gastrectomy for gastric cancer
Subtotal gastrectomy for gastric cancer
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DOI：
10.3748/wjg.v20.i38.13667
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发表时间：
2014-10-14
影响因子：
4.3
通讯作者：
Santoro, Eugenio
中科院分区：
文献类型：
--
作者：
Santoro, Roberto;Ettorre, Giuseppe Maria;Santoro, Eugenio
尽管上个世纪全世界胃癌的发病率和死亡率稳步下降，但由于人口老龄化，每年新发病例的绝对数量仍在增加。迄今为止，具有治愈目的的手术切除是唯一带来治愈希望的治疗方法。因此，胃癌手术已成为消化外科的一个专业领域。癌症患者的胃切除术和淋巴结清扫术仍然是一项具有挑战性的手术，需要熟练且训练有素的外科医生，他们非常熟悉胃癌手术快速发展的肿瘤学原理。事实上，胃切除和淋巴结清扫的范围取决于病变的大小，胃癌手术已成为患者和“针对疾病量身定制”的手术，范围从内镜切除到腹腔镜辅助胃切除和传统的扩大多脏器切除。淋巴结转移是接受根治性切除的患者最重要的预后因素。淋巴结解剖仍然是手术中最具挑战性的部分，因为淋巴结站位于主要腹膜后血管和邻近器官周围，这些器官通常不包含在切除标本中，需要保存以避免危险的术中和术后并发症。因此，外科医生是胃癌最重要的非TMN预后因素。胃大部切除术是中段和远端三分之一胃癌的首选治疗方法，因为与全胃切除术相比，它提供相似的生存率和更好的功能结果，特别是在预后良好的早期疾病中。尽管如此，中三分之一胃癌病例的切除范围和早期淋巴结清扫的范围仍存在争议。由于晚期胃癌需要更长时间的手术以及早期胃癌更保守治疗的趋势，传统胃大部切除术的适应症取决于多个变量。本次审查旨在澄清和定义该手术的实际标志以及与所有新旧治疗方法相比它所发挥的作用。 (C) 2014 百事登出版集团有限公司版权所有。
Although a steady decline in the incidence and mortality rates of gastric carcinoma has been observed in the last century worldwide, the absolute number of new cases/year is increasing because of the aging of the population. So far, surgical resection with curative intent has been the only treatment providing hope for cure; therefore, gastric cancer surgery has become a specialized field in digestive surgery. Gastrectomy with lymph node (LN) dissection for cancer patients remains a challenging procedure which requires skilled, well-trained surgeons who are very familiar with the fast-evolving oncological principles of gastric cancer surgery. As a matter of fact, the extent of gastric resection and LN dissection depends on the size of the disease and gastric cancer surgery has become a patient and "disease-tailored" surgery, ranging from endoscopic resection to laparoscopic assisted gastrectomy and conventional extended multivisceral resections. LN metastases are the most important prognostic factor in patients that undergo curative resection. LN dissection remains the most challenging part of the operation due to the location of LN stations around major retroperitoneal vessels and adjacent organs, which are not routinely included in the resected specimen and need to be preserved in order to avoid dangerous intra-and postoperative complications. Hence, the surgeon is the most important non-TMN prognostic factor in gastric cancer. Subtotal gastrectomy is the treatment of choice for middle and distal-third gastric cancer as it provides similar survival rates and better functional outcome compared to total gastrectomy, especially in early-stage disease with favorable prognosis. Nonetheless, the resection range for middle-third gastric cancer cases and the extent of LN dissection at early stages remains controversial. Due to the necessity of a more extended procedure at advanced stages and the trend for more conservative treatments in early gastric cancer, the indication for conventional subtotal gastrectomy depends on multiple variables. This review aims to clarify and define the actual landmarks of this procedure and the role it plays compared to the whole range of new and old treatment methods. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.