关键词: 早期胃癌, 内镜治疗, 外科治疗, 术后辅助化疗

Abstract: Current Status and Future Trend of Treatment for Early Gastric Cancer in Japan        CHENG Ming*，YAN Shang-cheng，PENG Wei，et al. *Department of Gastrointestinal Surgery，the Second Affiliated Hospital of Soochow University，Suzhou 215004，China 
Corresponding author：WU Yong-you，E-mail: wuyoyo@ aliyun.com
Abstract    Currently, minimally invasive, stomach-preserving, function-preserving and tailored treatment has become a predominant feature of early gastric cancer(EGC) treatment in Japan. In terms of endoscopic treatment, the indication and curability evaluation system has been further improved. In terms of surgical treatment, D1+ lymph node dissection is recommended for patients without lymph node metastasis and D2 lymph node dissection is performed for patients with suspected or obvious lymph nodes metastasis. Although minimally invasive surgery for EGC has been widely adopted in clinical practice, based on clinical researches available, the 6th edition of Japanese Gastric Cancer Treatment Guideline is still cautious about the indications for minimally invasive surgery. For clinical stage I patients, laparoscopic distal gastrectomy is strongly recommended, while laparoscopic proximal gastrectomy, total gastrectomy, and robotic gastrectomy are only weakly recommended. Sentinel lymph node biopsy combined with lymphatic basin dissection and laparoscopic endoscopic cooperative surgery are expected to further reduce the extent of gastrectomy and nodal dissection. Pylorus-preserving gastrectomy and proximal gastrectomy are being carried out more and more widely, while they are weakly recommended by guideline. For digestive tract reconstruction after proximal gastrectomy, esophagogastrostomy, double-tract reconstruction, and jejunal interposition are recommended, but currently the mainstream methods are double-flap technique, modified Side Overlap with Fundoplication by Yamashita and double-tract reconstruction. The omentum preservation is recommended for EGC surgery, while it is still controversial as to the preservation of vagus nerve. Based on the evidence available, postoperative adjuvant chemotherapy is not recommended for EGC even with lymph node metastasis. In the future, the treatment of EGC will be more precise. Minimally invasive or non-invasive, function preserving and individualized treatment will become more popular.

Key words: early gastric cancer, surgical treatment, endoscopic treatment, postoperative adjuvant chemotherapy