Yokota Takashi, Ishiyama Shuichi, Saito Toshihiro, Teshima Shin, Shimotsuma Masataka, Yamauchi Hidemi
Department of Gastroenterological Surgery, Sendai National Hospital, Sendai, Japan.
Lancet Oncol. 2003 Jul;4(7):423-8. doi: 10.1016/s1470-2045(03)01140-9.
Surgical practice for gastric cancer in Japan is based on the Gastric Cancer Treatment Guidelines issued in 2001 by the Japanese Gastric Cancer Association. These recommendations list options for treatment of each stage of cancer, with clear distinctions between interventions recommended for routine use and those that should be confined to trial settings until further evidence for their curative potential becomes available. In this review, we discuss standard surgery, local resection, segmental resection, and pylorus-preserving gastrectomy (PPG) as examples of limited resection and describe in detail the indications for limited lymph-node dissection in cases of early-stage gastric cancer. At present, evidence does not support the conclusion that limited surgery is effective for local resection or for improving quality of life. Thus, use of limited surgery should be considered an experimental approach both in Japan and the West. We conclude that surgeons who are familiar with the criteria for selecting surgical procedures should decide on a case-by-case basis which technique is most appropriate. Choices should be made with consideration of the stage of the cancer, invasiveness of the surgical procedure, and the patient's history. For all procedures, the patient must give informed consent and the surgeons must accurately assess the success of the operation after surgery.
日本的胃癌外科手术实践基于日本胃癌协会2001年发布的《胃癌治疗指南》。这些建议列出了癌症各阶段的治疗选择，明确区分了常规使用的干预措施和那些在有更多治愈潜力证据之前应仅限于试验环境的措施。在本综述中，我们讨论标准手术、局部切除、节段性切除和保留幽门胃切除术（PPG）作为有限切除的示例，并详细描述早期胃癌病例中有限淋巴结清扫的指征。目前，证据并不支持有限手术对局部切除或改善生活质量有效的结论。因此，在日本和西方，有限手术的应用都应被视为一种试验性方法。我们得出结论，熟悉手术程序选择标准的外科医生应根据具体情况决定哪种技术最合适。选择时应考虑癌症分期、手术的侵袭性和患者病史。对于所有手术，患者必须给予知情同意，外科医生必须在术后准确评估手术的成功率。
