Zhang Heng, Sang Jiangyong, Liu Fenglin
Department of General Surgery, Zhongshan Hospital of Fudan University, Shanghai 200032, China.
Department of General Surgery, The Second People's Hospital of Kashi, Xinjiang Uygur Autonomous Region District, Kashi 844000, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Aug 25;20(8):847-851.
With the introduction and promotion of "precision medicine" conception, the history of disease occurrence, progression and prognosis has been deeply investigated with more accuracy, and the surgical treatment concept has become more precise and minimally invasive. With the rapid development of minimally invasive technique, laparoscopic gastrectomy has become an important part for treatment of gastric cancer. A number of randomized controlled clinical trials, such as KLASS-01 and CLASS-01, have demonstrated that laparoscopic gastrectomy is safe and feasible for treatment of early and locally advanced gastric cancer, respectively. Endoscopic treatment would also be considered with strict indications. The surgical safety is identical between standard laparoscopy surgery and open surgery for local advanced gastric cancer. Radical cure, organ function preservation and reduced surgical trauma are the basic rules for minimally invasive treatment for gastric cancer. Specialized treatment mode, which consists of precise evaluation of tumor location, gastrectomy and lymph node resection, reduced surgical trauma and control of postsurgical complications, is the premise for implementation of minimally invasive surgery. Accurate preoperative staging, strict indication of operation, accurate quality control and postoperative management are important warrants for the effect of minimally invasive treatment in patients with gastric cancer. With standard diagnosis and treatment procedures, the specialized treatment mode for gastric cancer combined with standard surgical resection is an important force to promote the development of minimally invasive surgery. And what should we do to train and promote gastric cancer treatment in primary medical care centers is an urgent problem. With the development of equipment, minimally invasive treatment will be more professional, more precise, safer and less invasive. In the era of precision medicine, with deeper exploring the pathogenesis of gastric cancer, promoting the development of specialized treatment mode and strengthened surgical team training could meet the demand for minimally invasive treatment of gastric cancer. Therefore, specialized minimally invasive treatment is the trend of minimally invasive treatment for gastric cancer in the new era.
随着“精准医学”理念的引入与推广,对疾病发生、发展及预后的过程有了更精确深入的研究,手术治疗理念也变得更加精准和微创。随着微创技术的迅速发展,腹腔镜胃癌切除术已成为胃癌治疗的重要组成部分。多项随机对照临床试验,如KLASS - 01和CLASS - 01,分别证明了腹腔镜胃癌切除术治疗早期和局部进展期胃癌是安全可行的。内镜治疗也会在严格适应证下被考虑。对于局部进展期胃癌,标准腹腔镜手术与开放手术的手术安全性相当。根治性切除、保留器官功能及减少手术创伤是胃癌微创治疗的基本原则。由对肿瘤位置的精准评估、胃切除及淋巴结清扫、减少手术创伤和控制术后并发症组成的专业化治疗模式是实施微创手术的前提。准确的术前分期、严格的手术适应证、精确的质量控制及术后管理是胃癌患者微创治疗效果的重要保障。采用标准的诊疗程序,结合标准手术切除的胃癌专业化治疗模式是推动微创手术发展的重要力量。而在基层医疗中心如何培训和推广胃癌治疗是一个亟待解决的问题。随着设备的发展,微创治疗将更加专业化、精准化、安全化且创伤更小。在精准医学时代,深入探究胃癌发病机制、推动专业化治疗模式发展及加强手术团队培训能够满足胃癌微创治疗的需求。因此,专业化微创治疗是新时代胃癌微创治疗的趋势。