Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan.
Cancer Commun (Lond). 2019 Mar 27;39(1):11. doi: 10.1186/s40880-019-0360-1.
The Japan Clinical Oncology Group has recently conducted large scale clinical trials with findings that have revealed pivotal strategies for the treatment of resectable gastric cancer surgery. These findings include the fact that D3 lymphadenectomy does not improve survival rates when compared to D2 lymphadenectomy, and it is not recommended for resectable gastric cancer. Also, a transhiatal approach is recommended, instead of the left thoraco-abdominal approach, for the treatment of adenocarcinoma of the esophago-gastric junction or gastric cardia which has invaded ≤ 3 cm of the esophagus. Gastrectomy with splenectomy and bursectomy had been recommended as a part of the D2 lymphadenectomy. However, the results of the recent clinical trials revealed that splenectomy should be avoided in total gastrectomy with D2 lymphadenectomy for proximal gastric cancer and that bursectomy should be avoided in gastrectomy with D2 lymphadenectomy for resectable gastric cancer. Both splenectomy and bursectomy were found to be unable to improve survival, but instead increased operative morbidity. These trials revealed that the above-mentioned invasive and aggressive procedures did not provide sufficient survival benefits and that gastric cancer surgery may be trending from an "invasive to less invasive" and "aggressive to more conservative" approach.
日本临床肿瘤学会最近进行了大规模的临床试验，结果为可切除胃癌手术的治疗提供了关键策略。这些发现包括 D3 淋巴结清扫术与 D2 淋巴结清扫术相比并未提高生存率，因此不推荐用于可切除的胃癌；对于侵犯食管≤3cm 的食管胃交界部或胃贲门腺癌，建议采用经食管裂孔而非左胸腹入路进行治疗。脾切除术和胆囊切除术曾被推荐作为 D2 淋巴结清扫术的一部分。然而，最近的临床试验结果表明，对于近端胃癌的 D2 淋巴结清扫术全胃切除术应避免脾切除术，对于可切除胃癌的 D2 淋巴结清扫术应避免胆囊切除术。脾切除术和胆囊切除术均未改善生存，反而增加了手术并发症。这些试验表明，上述侵袭性和激进性手术并未提供足够的生存获益，胃癌手术可能正从“侵袭性到非侵袭性”和“激进性到更保守性”的方向发展。
