Morgagni Paolo, La Barba Giuliano, Colciago Eleonora, Vittimberga Giovanni, Ercolani Giorgio
Department of General Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy.
Department of Surgery and Translational Medicine, Milano-Bicocca University, San Gerardo Hospital, Monza, Italy.
Updates Surg. 2018 Jun;70(2):213-223. doi: 10.1007/s13304-018-0552-2. Epub 2018 Jun 23.
The optimal management of patients with resection line involvement after endoscopic or surgical treatment for gastric cancer is debated. In contrast to previous reports, we examined both the experience of endoscopists and surgeons in early-stage lesions and the wide variation in treatments proposed for advanced disease in case of infiltration of resection margins. A PubMed search for papers using the key words: gastric or stomach cancer, or Carcinoma; gastrectomy and positive margins; surgical margins or resection line or endoscopic margin involvement; and R1 resection, from January 2000 to July 2015 was undertaken. Fifty-three studies were considered pertinent to the study. Many endoscopists report that some cases of early gastric cancer with resection line involvement after endoscopic resection have good outcomes notwithstanding incomplete resection, but few surgeons share this opinion. Conversely, it is unanimously agreed that very advanced stages should not be surgically retreated because they are expression of systemic disease. Between early and very advanced cancer the usefulness of re-resection for microscopic resection lines involvement is still debated and surgery may be proposed only when radicality can be achieved. When surgery is not feasible, radiochemotherapy may represent a valid alternative.
对于接受过内镜或手术治疗的胃癌患者，若出现切除线受累，其最佳治疗方案仍存在争议。与既往报道不同，我们既考察了内镜医师和外科医师处理早期病变的经验，也探讨了在切除边缘浸润的情况下，针对晚期疾病所提出的治疗方案的广泛差异。我们在PubMed数据库中进行了检索，使用的关键词为：胃癌；胃切除术及切缘阳性；手术切缘、切除线或内镜切缘受累；以及R1切除，检索时间范围为2000年1月至2015年7月。共筛选出53项与本研究相关的研究。许多内镜医师报告称，部分内镜切除术后出现切除线受累的早期胃癌病例，尽管切除不完全，但预后良好，然而很少有外科医师认同这一观点。相反，大家一致认为，对于极晚期病例不应进行手术再治疗，因为这表明存在全身性疾病。在早期和极晚期癌症之间，对于显微镜下切除线受累进行再次切除的有效性仍存在争议，仅在能够实现根治性切除时才可能考虑手术。当手术不可行时，放化疗可能是一种有效的替代方案。
