Abstract:

Development and trends in Japanese gastric surgery: experiences from Japanese Gastric Cancer Treatment Guidelines (ver. 5)        HAN Fang-hai, YANG Bin. Department of Gastrointestinal Surgery，Sun Yat-sen Memorial Hospital，Sun Yat-sen University，Guangzhou 510120，China
Corresponding author: HAN Fang-hai, E-mail: FH_han@163.com
Abstact    The Japanese Gastric Cancer Treatment guidelines has been revised for 5 times since it was first issued on March 2001. The original versions were mainly based on retrospectively studies and expert consensus. The New guideline and classification are established based on the best recent clinical evidence，and it addresses several important clinical issues including non-curative surgery for advanced gastric cancer with non-curable factors，bursectomy，splenectomy for advanced proximal gastric cancer，gastric cancers invading distal esophagus，etc. New edition also releases the clinical questions of neoadjuvant chemotherapy, D2+paraaortic lymph node dissection, diagnostic criteria of peritoneal dissemination by staging laparoscopy，the definition and extent of the lymph node dissection for EGJ cancer and remnant gastric cancer.

Key words: gastric cancer, Japanese Gastric Cancer Association, guidline

摘要：

日本《胃癌治疗指南》自2001年3月制定以来进行了5次修订，其建立在日本大量经验性数据基础上，采用教科书形式介绍，但第5版《胃癌治疗指南》体现出从经验外科向循证医学外科的转变，包括非治愈性胃癌的减瘤手术、网膜囊外切除、近端和胃体部癌合并脾切除、胃癌侵犯食管的手术入路问题等，采纳了国际多中心临床试验（MRCT）研究结果。推荐cStageⅠ胃癌为腹腔镜手术适应证，而对于进展期胃癌正在进行MRCT（JLSSG0901）研究，有待结果发表。改变单一手术模式，注重术前新辅助化疗，对于临界可切除的高度淋巴结转移病例，进行新辅助化疗（SP方案）2~3疗程后，再行D2+No.16淋巴结清扫。对于胃癌腹膜转移的腹腔镜诊断标准以及食管胃结合部癌和残胃癌区域淋巴结定义和清扫范围，指南提出了日本标准，有待循证医学检验。

关键词: 胃癌, 日本胃癌学会, 指南