Giuliani Andrea, Miccini Michelangelo, Basso Luigi
Andrea Giuliani, Michelangelo Miccini, Luigi Basso, Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Medical School, Policlinico "Umberto I", 00161 Rome, Italy.
World J Gastroenterol. 2014 Apr 14;20(14):3889-904. doi: 10.3748/wjg.v20.i14.3889.
Gastric cancer is one of the leading causes of death for cancer worldwide, although geographical variations in incidence exist. Over the last decades, its incidence and mortality have gradually decreased in Western countries, while these have increased, or remained stable, in the other world regions. Gastric cancer is often diagnosed at an advanced stage, with the only notable exception of Japan, where nationwide screening programs are enforced, due to local high incidence. Curative- intent surgery (i.e., gastrectomy, total or partial, and lymphadenectomy) remains the cornerstone of treatment of gastric cancer. Much has been debated about the extent of lymph node dissection and, although it is a valuable contribution to staging and cure, operative treatment only represents one aspect of overall effective management, as the risk of both locoregional and distant recurrences are high, and bear a poor prognosis. As a matter of fact, surgery, as a single modality treatment, has probably achieved its maximum efficacy for local control and survival, while other accompanying nonsurgical treatment modalities have to be taken into account, although their role is still the subject of considerable debate. The authors in this review present an update on the outcome of treatment of gastric cancer in relation to the extent of lymphadenectomy and of various nonsurgical preoperative, intraoperative, and postoperative strategies.
胃癌是全球癌症死亡的主要原因之一，尽管其发病率存在地域差异。在过去几十年中，西方国家的胃癌发病率和死亡率逐渐下降，而在世界其他地区，发病率则有所上升或保持稳定。胃癌通常在晚期才被诊断出来，唯一显著的例外是日本，由于当地发病率高，日本实施了全国性的筛查计划。根治性手术（即全胃或部分胃切除术以及淋巴结清扫术）仍然是胃癌治疗的基石。关于淋巴结清扫范围的争论很多，尽管它对分期和治愈有重要贡献，但手术治疗只是整体有效管理的一个方面，因为局部和远处复发的风险都很高，预后较差。事实上，作为单一治疗方式的手术，在局部控制和生存方面可能已经达到了最大疗效，尽管其他非手术治疗方式的作用仍存在很大争议，但仍需考虑。本综述的作者介绍了与淋巴结清扫范围以及各种非手术术前、术中和术后策略相关的胃癌治疗结果的最新情况。
