Russo Ashley, Strong Vivian E
Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Transl Gastroenterol Hepatol. 2017 Apr 30;2:38. doi: 10.21037/tgh.2017.03.14. eCollection 2017.
The World Health Organization (WHO) has declared gastric carcinoma a global health concern and gastric cancer remains the third leading cause of cancer deaths worldwide. With the rising incidence of gastric cancer, a body of both retrospective and randomized data has emerged since the early 1990's evaluating the role of minimally invasive platforms in the management of gastric cancer. While Eastern studies have shown that the laparoscopic approach is safe and feasible for advanced gastric cancer in Eastern patients, it is not clear whether this is true for patients in the West. Differences in tumor biology, stage at presentation, institutional volume, and surgeon experience all may impact the efficacy and widespread utilization of minimally invasive approaches in regions where gastric cancer is less prevalent. The majority of studies have pointed to a number of improvements associated with minimally invasive approaches including decreased blood loss, shorter length of hospital stay, lower analgesic requirements, decreased minor complications, and faster recovery without any significant difference in overall or disease specific survival (DSS). The benefits associated with minimally invasive approaches and evidence supporting similar oncologic outcomes compared to the traditional open approach will hopefully expand the indications for minimally invasive surgery in the management of gastric cancer. In the United States, results following initial experiences with minimally invasive techniques, including robotic platforms, have revealed promising results. Well-established laparoscopic and robotic techniques are emerging, particularly from high volume United States institutions, which will hopefully pave the way for increased utilization of minimally invasive surgery for gastric cancer in the West.
世界卫生组织（WHO）已宣布胃癌为全球卫生关注重点，胃癌仍是全球癌症死亡的第三大主要原因。随着胃癌发病率的上升，自20世纪90年代初以来，出现了大量回顾性和随机数据，评估微创平台在胃癌治疗中的作用。虽然东方的研究表明，腹腔镜手术方法对东方患者的晚期胃癌是安全可行的，但对于西方患者是否如此尚不清楚。肿瘤生物学、就诊时的分期、机构规模和外科医生经验的差异都可能影响在胃癌不太普遍的地区微创方法的疗效和广泛应用。大多数研究指出了与微创方法相关的一些改善，包括失血减少、住院时间缩短、镇痛需求降低、轻微并发症减少以及恢复更快，总体生存率或疾病特异性生存率（DSS）没有任何显著差异。与微创方法相关的益处以及与传统开放手术相比支持相似肿瘤学结果的证据，有望扩大微创手术在胃癌治疗中的适应证。在美国，包括机器人平台在内的微创技术的初步经验结果显示出了令人鼓舞的结果。成熟的腹腔镜和机器人技术正在兴起，特别是来自美国大型机构，这有望为西方增加胃癌微创手术的应用铺平道路。
