中国实用外科杂志

中国实用外科杂志 ›› 2022, Vol. 42 ›› Issue (10): 1126-1131.DOI: 10.19538/j.cjps.issn1005-2208.2022.10.11

• 专题笔谈 • 上一篇    下一篇

早期胃癌内镜黏膜下剥离术后追加手术的时机与术式选择

刘凤林，蔡天翼   

  1. 复旦大学附属中山医院普通外科，上海 200032 
  • 出版日期:2022-10-01 发布日期:2022-10-13

  • Online:2022-10-01 Published:2022-10-13

摘要： 内镜治疗技术的发展推动了早期胃癌的早诊早治。然而，随着内镜黏膜下剥离术（ESD）治疗适应证的逐步扩大，非治愈性切除病例也呈现增多趋势。因此，对于该类病人的补救处理值得进一步探讨并规范统一。结合日本胃癌学会（JGCA）、欧洲肿瘤内科学会（ESMO）及美国国家综合癌症网络（NCCN）指南和各项相关临床研究，并回顾性分析单中心数据后可得出结论，内镜切除根治度C（eCura-C）的病人具有相对较高的癌残留和淋巴结转移风险，对于此类非治愈性切除的病人，ESD后的补救处理建议以外科手术为主，但仍须结合具体的非治愈性因素及病人一般情况进行个体化治疗，因为追加手术仍有较高的术后病理学无癌残留和手术并发症的风险。追加手术时机和术式选择已基本明确，其中淋巴结清扫范围可参考早期胃癌相关规定，如何进一步缩小手术范围，最大程度保留胃功能仍是未来术式选择的研究重点。如何准确预测非治愈性切除病人的淋巴结转移、精准前哨淋巴结活检、可疑转移淋巴结示踪及腹腔镜内镜联合手术是未来的发展方向。

关键词: 早期胃癌, 内镜治疗, 非治愈性切除, 补救手术, 内镜黏膜下剥离术

Abstract: The timing and selection of additional operation after treatment of ESD for early gastric cancer        LIU Feng-lin, CAI Tian-yi.Department of General Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China
Corresponding author:LIU Feng-lin,E-mail: liu.fenglin@zs-hospital.sh.cn
Abstract    The development of endoscopic therapy has promoted the early diagnosis and treatment of early gastric cancer （EGC）, nevertheless, as the indication of EGC treated with ESD gradually expands, non-curative resection is on the rise at the same time. Therefore, the standard of remedial treatment for such patients is worthy of further discussion and unification. Based on the international guidelines of the Japanese Gastric Cancer Association (JGCA), the European Society of Medical Oncology (ESMO), the National Comprehensive Cancer Network (NCCN), the relevant clinical studies in various countries, as well as the review of single-center data, it can be concluded that patients with eCura-C have a relatively high risk of residual cancer and lymph node metastasis. It is suggested that the remedial treatment for such non-curative resection（NCR） patients after ESD be mainly surgery, but it is still necessary to take specific non-curative factors and the general condition of such patients into consideration before individualized treatment is made because additional surgery still has a relatively high risk of postoperative pathology without residual cancer and surgical complications. The operation timing and the surgical methods of additional salvage surgery are roughly clear, as the scope of lymph node dissection of which can be referred to as the relevant provisions of early gastric cancer. It is still future research focus of surgical methods to figure out how to further reduce the scope of surgery and maximize the preservation of gastric function. To accurately predict lymph node metastasis in NCR patients, accurate sentinel lymph node biopsy, suspicious lymph node tracing, and laparoscopic-endoscopic combined surgery is the future research direction. 

Key words: early gastric cancer, endoscopic therapy, non-curative resection, salvage surgery, endoscopic submucosal dissection