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首页> 外文会议>St. Gallen EORTC Gastrointestinal Cancer Conference >Part VI Gastric Cancer Optimal Surgery for Gastric Cancer: Is More Always Better?
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Part VI Gastric Cancer Optimal Surgery for Gastric Cancer: Is More Always Better?

机译：部分VI胃癌胃癌最佳手术：更始终更好吗？

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The extent of surgical resection for carcinoma of the stomach has been debated for many years. The aims of surgery are to obtain complete histopathological clearance of all possible sites of disease based on oncological principles. This has included radical resection of the primary site with combined organ resection as required and resection of associated lymph nodes. Detailed understanding of the natural history of gastric cancer has resulted in the Pichlmayr total gastrectomy "en principe" approach being super-ceded by a tailored approach according to tumour and patient characteristics. Careful tumour staging is fundamental to the selection of surgical intervention. Endoscopic therapy is recommended for well differentiated, mucosal cancers less than 2 cm in size as the risk of nodal disease is 0—3 %. Recently, these criteria have been extended to include some larger and ulcerated cancers. Although extended lymphadenectomy has formed the basis of radical surgery, Japanese experience has also confirmed that for early gastric cancer involving the submucosa limited nodal resection can achieve the same outcome as standardised D2 lymphadenectomy. The approach to locally advanced T2, T3 and some T4 cancers has been defined by the Japanese rules specifying proximal and distal margins as well as extent of lymph node resection. Translation of Japanese results to Western patients has not been straightforward. Two randomised controlled trials have shown limited or no benefit over conventional limited nodal dissection. However, these studies have not been without criticism and individual specialist practice in the West now preferentially includes D2 lymphadenectomy in suitable patients. Extending conventional D2 lymphadenectomy has been evaluated but the results are not conclusive. Japanese RCTs have not shown an advantage but in selected cases several groups have reported a benefit. Historically, radical gastric surgery in the West was associated with significant morbidity and mortality reflecting the comorbidity of the patient groups. Perioperative approaches have shown that outcome approaching that of radical surgery can be achieved with multimodal therapies for high-risk patient groups for whom radical surgery would be contraindicated. Surgery for gastric cancer needs to be determined by a multidisciplinary team to ensure appropriate procedure selection for an individual patient. This allows all relevant information to be considered and to provide the best chance for high-quality patient outcome.
机译：胃癌癌的手术切除程度多年来一直讨论。手术的目标是基于肿瘤学原理获得所有可能的疾病疾病的完全组织病理学清除。这包括根据需要和切除相关淋巴结的组合器官切除和切除相关淋巴结的根本切除。详细了解胃癌自然病史导致PICHLMAYR总胃切除术“en Principe”方法通过根据肿瘤和患者特征进行量身定制的方法超级割草。仔细的肿瘤分期是选择外科干预的基础。建议内镜治疗良好分化，粘膜癌小于2厘米，随着节点疾病的风险为0-3％。最近，这些标准已经扩展到包括一些更大和溃疡的癌症。虽然延长的淋巴结切除术形成了自由基手术的基础，但日本经验也证实，对于涉及粘膜下的早期胃癌，患有粘膜下的节点切除术可以达到标准化D2淋巴结切除术的相同结果。本地先进的T2，T3和一些T4癌的方法已经由日本规则指定近端和远端边距以及淋巴结切除的程度来定义。日本结果翻译为西方患者并不直接。两种随机对照试验表明，在常规有限的节点解剖中显示有限或没有益处。然而，这些研究没有批评，现在西方的个人专家实践现在优先在合适的患者中包含D2淋巴结切除术。已经评估了延伸的常规D2淋巴结切除术，但结果并非决定。日本RCT没有显示出优势，但在选定的情况下，几个小组报告了一个好处。从历史上看，西方的激进胃手术与反射患者组的合并症的显着发病率和死亡率有关。围手术期方法表明，可以通过多式化患者组的多峰疗法来​​实现接近自由基手术的结果，其中高危患者群体将被激进手术将被禁忌。胃癌的手术需要由多学科团队决定，以确保个体患者的适当程序选择。这允许考虑所有相关信息，并为高质量的患者结果提供最佳机会。

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