Marrelli Daniele, De Franco Lorenzo, Iudici Livio, Polom Karol, Roviello Franco
Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy.
Transl Gastroenterol Hepatol. 2017 Jan 17;2:3. doi: 10.21037/tgh.2017.01.01. eCollection 2017.
The extent of lymphadenectomy in gastric cancer (GC) surgery has been for long time a matter of debate. Randomized trials performed in the West reported worse results of D2 dissection, in terms of postoperative complications and long-term survival benefit, than Eastern series and observational studies from specialized Western centers. However, long-term re-evaluation of such trials and in depth-analysis of other experiences demonstrated the potential benefit of D2 in reducing the probability of cancer-related death and the safety of this procedure when avoiding unnecessary spleno-pancreatectomy and in centers with ad adequate surgical volume. Nowadays, the D2 is considered the standard treatment in most guidelines all over the world. More limited procedures (D1, D1 plus) may be adequate in selected cases, and more extended dissections (D2 plus) could be indicated in advanced forms with high risk of metastases to distant nodes, but in specialized centers or in the setting of clinical studies. The integration with neoadjuvant therapies and multimodality approach could offer a chance of cure in groups of patients with poor results when approached with standard treatment.
胃癌（GC）手术中淋巴结清扫的范围长期以来一直是一个有争议的问题。在西方进行的随机试验报告称，与东方系列研究以及西方专业中心的观察性研究相比，D2清扫术在术后并发症和长期生存获益方面的结果更差。然而，对这些试验的长期重新评估以及对其他经验的深入分析表明，D2清扫术在降低癌症相关死亡概率方面具有潜在益处，并且在避免不必要的脾胰切除术以及在手术量充足的中心进行该手术时是安全的。如今，D2清扫术在全球大多数指南中被视为标准治疗方法。在某些特定情况下，更有限的手术方式（D1、D1加）可能就足够了，而对于远处淋巴结转移风险高的晚期病例，可能需要更广泛的清扫术（D2加），但这通常在专业中心或临床研究背景下进行。与新辅助治疗和多模式方法相结合，对于采用标准治疗效果不佳的患者群体而言，可能提供治愈的机会。
