Abstract:

Value and reasonable selection of surgery in advanced gastric cancer        LI Zi-yu，XUE Kan，JI Jia-fu. Key Laboratory of Carcinogenesis and Translational Research （Ministry of Education），Gastrointestinal Cancer Center，Peking University Cancer Hospital & Institute，Beijing 100142，China
Corresponding author：JI Jia-fu，E-mail：jijiafu@hsc.pku.edu.cn
Abstract    Advanced gastric cancer has poor prognosis. Chemotherapy or with targeted drug is the primary treatment. Retrospective studies implied that surgery could relieve emergencies such as bleeding and obstruction，as well as improve survival for selected patients. In addition，the progress of drug therapy gave birth to the concept of conversion therapy，which further affirmed the value of surgery in advanced gastric cancer. However, it is still lack of evidence in the choice of surgical group, surgery opportunity, operation scope and postoperative treatment. Based on the advanced gastric cancer classification proposed by the authors’ center, every patient should be discussed through MDT. For resectable tumor with less burden, the principle resembles neoadjuvant chemotherapy and the surgery aims at R0. For unresectable tumor with more burden, surgery is only conducted in patients after effective systemic therapy, and the ideal surgery should be performed after effective treatment and also before drug resistance. The operation scope should also consider the complication and slow postoperative recovery which possibly delay or interrupt systemic treatment. Postoperative systemic treatment should be considered. However, systemic treatment is still the cornerstone of advanced gastric cancer. Surgery should still be performed cautiously in highly selected patients before more solid evidence existed. The treatment effect depends on further exploration of effective drugs and genotyping markers.

Key words: advanced gastric cancer, surgery, conversion therapy

摘要：

晚期胃癌预后差，主要治疗方式为化疗或联合靶向药物的系统治疗。外科手术除了可解决出血、梗阻等急症外，部分病人生存亦可获益。此外，药物治疗的进展也推动了转化治疗概念的衍生，进一步肯定了外科手术在晚期胃癌治疗中的价值。然而，晚期胃癌手术人群、手术时机、手术范围以及术后治疗等选择仍缺乏证据。基于北京大学肿瘤医院提出的晚期胃癌分型，经过多学科综合治疗协作组（MDT）讨论后，对于负荷量较小的初始可切除型肿瘤，治疗原则类似于新辅助化疗，争取达到R0切除；对于负荷量较大的初始不可切除型肿瘤，手术仅在系统治疗有效的病人中选择性施行，尚未出现耐药是较合适的时机，手术范围也应考虑并发症、术后恢复等对系统治疗中断的影响，施行手术的病人术后有必要进行系统治疗。系统治疗仍是晚期胃癌治疗的基石，在有更多的证据之前，外科手术应在高度选择的人群中谨慎施行，而治疗效果仍寄希望于相关有效药物及基因分型标识的进一步发掘。

关键词: 晚期胃癌, 手术, 转化治疗