Park Do Joong, Park Young Suk, Ahn Sang Hoon, Kim Hyung Ho
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Korean J Gastroenterol. 2017 Sep 25;70(3):134-140. doi: 10.4166/kjg.2017.70.3.134.
Recently, the incidence of upper third gastric cancer has increased, and with it the number of endoscopic submucosal dissection (ESD) procedures performed has been increasing. However, if ESD is not indicated or non-curable, surgical treatment may be necessary. In the case of lower third gastric cancer, it is possible to preserve the upper part of the stomach; however, in the case of upper third gastric cancer, total gastrectomy is still the standard treatment option, regardless of the stage. This is due to the complications associated with upper third gastric cancer, such as gastroesophageal reflux after proximal gastrectomy rather than oncologic problems. Recently, the introduction of the double tract reconstruction method after proximal gastrectomy has become one of the surgical treatment methods for upper third early gastric cancer. However, since there has not been a prospective comparative study evaluating its efficacy, the ongoing multicenter prospective randomized controlled trial (KLASS-05) comparing laparoscopic proximal gastrectomy with double tract reconstruction and laparoscopic total gastrectomy is expected to be important for determining the future of treatment of upper third early gastric cancer.
最近，胃上部癌的发病率有所上升，随之而来的是内镜下黏膜下剥离术（ESD）的实施数量也在增加。然而，如果ESD不适用或无法治愈，则可能需要进行手术治疗。对于胃下部癌，可以保留胃的上部；然而，对于胃上部癌，无论处于何种分期，全胃切除术仍然是标准的治疗选择。这是由于胃上部癌相关的并发症，如近端胃切除术后的胃食管反流，而非肿瘤学问题。最近，近端胃切除术后双通路重建方法的引入已成为胃上部早期癌的手术治疗方法之一。然而，由于尚未有评估其疗效的前瞻性对照研究，正在进行的比较腹腔镜近端胃切除术加双通路重建与腹腔镜全胃切除术的多中心前瞻性随机对照试验（KLASS-05），预计对于确定胃上部早期癌治疗的未来发展具有重要意义。
