Evolution of gastric surgery techniques and outcomes.
Evolution of gastric surgery techniques and outcomes.
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DOI：
10.1186/s40880-016-0134-y
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发表时间：
2016-07-26
影响因子：
--
通讯作者：
Ajani JA
中科院分区：
文献类型：
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作者：
Shiozaki H;Shimodaira Y;Elimova E;Wadhwa R;Sudo K;Harada K;Estrella JS;Das P;Badgwell B;Ajani JA
胃癌的外科治疗可提高生存率。然而，一段时间以来，外科医生对胃切除的范围有不同的看法。研究人员进行了许多临床研究，在确定最佳手术方法方面取得了缓慢但稳定的进展。淋巴结清扫的范围一直是胃癌手术的主要问题之一。许多试验表明，D2夹层导致的发病率和死亡率高于D1夹层。然而，长期结果表明，D2夹层比D1夹层的生存期更长。2004年，日本临床肿瘤学小组报告了一项关键性试验，该试验旨在确定主动脉旁淋巴结清扫联合D2清扫是否上级单独D2清扫，但未发现额外手术的获益。最初建议将胃切除术联合胰腺切除术、脾切除术和粘液囊切除术作为D2夹层的一部分。现在，保留胰腺的全胃切除术与D2剥离是标准的，正在进行的试验正在解决脾切除术的作用。此外，腹腔镜胃切除术的可行性和安全性也得到了很好的证实。生存和生活质量越来越被认为是最重要的终点。在这篇综述中，我们提出了手术技术和这些技术在胃癌患者中的重要试验的观点。
Surgical management of gastric cancer improves survival. However, for some time, surgeons have had diverse opinions about the extent of gastrectomy. Researchers have conducted many clinical studies, making slow but steady progress in determining the optimal surgical approach. The extent of lymph node dissection has been one of the major issues in surgery for gastric cancer. Many trials demonstrated that D2 dissection resulted in greater morbidity and mortality than D1 dissection. However, long-term outcomes demonstrated that D2 dissection resulted in longer survival than D1 dissection. In 2004, the Japan Clinical Oncology Group reported a pivotal trial which was performed to determine whether para-aortic lymph node dissection combined with D2 dissection was superior to D2 dissection alone and found no benefit of the additional surgery. Gastrectomy with pancreatectomy, splenectomy, and bursectomy was initially recommended as part of the D2 dissection. Now, pancreas-preserving total gastrectomy with D2 dissection is standard, and ongoing trials are addressing the role of splenectomy. Furthermore, the feasibility and safety of laparoscopic gastrectomy are well established. Survival and quality of life are increasingly recognized as the most important endpoints. In this review, we present perspectives on surgical techniques and important trials of these techniques in gastric cancer patients.