Minimally Invasive Surgery for Gastric Cancer: The Future Standard of Care
Minimally Invasive Surgery for Gastric Cancer: The Future Standard of Care
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DOI：
10.1007/s00268-011-1051-5
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发表时间：
2011-07-01
影响因子：
2.6
通讯作者：
Wakabayashi, Go
中科院分区：
文献类型：
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作者：
Koeda, Keisuke;Nishizuka, Satoshi;Wakabayashi, Go
Kitano等人于1991年首次报道了腹腔镜辅助远端胃切除术治疗胃癌。腹腔镜胃楔形切除术（LWR）和胃内粘膜切除术（IGMR）适用于局限于粘膜层且无淋巴结转移风险的胃癌。随着内镜粘膜切除术（EMR）和内镜粘膜下剥离术（ESD）的改进，LWR和IGMR在这些适应症中的使用减少，胃癌患者（包括有淋巴结转移风险的患者）更有可能接受腹腔镜胃切除术（LG）和淋巴结清扫术。许多回顾性比较试验和随机对照试验（RCT）已证实，LG是安全可行的，并且在早期胃癌（EGC）患者中的短期结局优于开腹胃切除术（OG）。然而，这些试验没有纳入令人满意的患者数量来建立临床证据。因此，需要额外的多中心随机对照试验来描述LG和OG之间显著的可量化差异。随着腹腔镜经验的积累，LG的适应症已经扩大到包括老年和超重患者以及晚期胃癌患者。此外，腹腔镜辅助全胃切除术、腹腔镜辅助近端胃切除术、腹腔镜辅助保留幽门胃切除术（PPG）和扩大淋巴结清扫术（D2）等先进技术已被广泛应用。前哨淋巴结导航和机器人手术将成为微创手术（MIS）的额外选择这些发展将改善胃癌手术后患者的生活质量。
Laparoscopy-assisted distal gastrectomy for gastric cancer was first reported by Kitano et al. in 1991. Laparoscopic wedge resection (LWR) and intragastric mucosal resection (IGMR) were quickly adapted for gastric cancer limited to the mucosal layer and having no risk of lymph node metastasis. Following improvements in endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), the use of LWR and IGMR for these indications decreased, and patients with gastric cancer, including those with a risk of lymph node metastases, were more likely to be managed with laparoscopic gastrectomy (LG) with lymph node dissection. Many retrospective comparative trials and randomized-controlled trials (RCT) have confirmed that LG is safe and feasible, and that short-term outcomes are better than those of open gastrectomy (OG) in patients with early gastric cancer (EGC). However, these trials did not include a satisfactory number of patients to establish clinical evidence. Thus, additional multicenter randomized-controlled trials are needed to delineate significantly quantifiable differences between LG and OG. As laparoscopic experience has accumulated, the indications for LG have been broadened to include older and overweight patients and those with advanced gastric cancer. Moreover, advanced techniques, such as laparoscopy-assisted total gastrectomy, laparoscopy-assisted proximal gastrectomy, laparoscopy-assisted pylorus-preserving gastrectomy (PPG), and extended lymph node dissection (D2) have been widely performed.In the near future, sentinel node navigation and robotic surgery will become additional options in minimally invasive surgery (MIS) involving LG. Such developments will improve the quality of life of patients following gastric cancer surgery.