Rosati Riccardo, Parise Paolo, Giannone Codiglione Fabio
Gastroenterological Surgery Unit, San Raffaele Hospital, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
Transl Gastroenterol Hepatol. 2016 Dec 27;1:93. doi: 10.21037/tgh.2016.12.04. eCollection 2016.
Laparoscopy has been introduced in treatment of gastric cancer to reduce surgical trauma and to improve post-operative functional recovery. Most of international guidelines allow the use of this minimally invasive approach in general surgical practice only in clinical stage I. One of the most important concerns in fact is the feasibility of D2 lymphadenectomy through laparoscopy. Reduced numbers of harvested lymph nodes have been reported, particularly in stations with a more difficult access. Nevertheless subsequent papers reported adequate numbers of total number of nodes retrieved, even with D2 dissection and even in complex stations but results from randomized controlled trials still lack. Laparoscopic approach has been proven safe and effective also in extremely complex maneuvers as spleen-preserving retropancreatic lymphadenectomy. The minimally invasive approach in D2 lymphadenectomy seems to be associated to comparable incidence of specific complications as compared to open surgery. The use of laparoscopy has extended the operating time but has reduced the blood loss. Because of high complexity of this kind surgery, laparoscopic gastric surgery for cancer should be done only in referral centers.
腹腔镜检查已被引入胃癌治疗，以减少手术创伤并促进术后功能恢复。大多数国际指南仅允许在临床I期的普通外科手术中使用这种微创方法。事实上，最重要的问题之一是通过腹腔镜进行D2淋巴结清扫的可行性。有报道称获取的淋巴结数量减少，尤其是在那些较难进入的部位。然而，随后的论文报道即使进行D2清扫，甚至在复杂部位，也能获取足够数量的淋巴结，但随机对照试验的结果仍然缺乏。腹腔镜手术在诸如保留脾脏的胰后淋巴结清扫等极其复杂的手术中也已被证明是安全有效的。与开放手术相比，D2淋巴结清扫的微创方法似乎与特定并发症的发生率相当。腹腔镜的使用延长了手术时间，但减少了失血量。由于这类手术的高度复杂性，腹腔镜胃癌手术应仅在转诊中心进行。
