Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215008, China; Department of Gastrointestinal Surgery, Affiliated Kunshan Hospital to Jiangsu University, Suzhou Jiangsu, 215300, China.
Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215008, China.
Asian J Surg. 2021 Jan;44(1):54-58. doi: 10.1016/j.asjsur.2020.09.006. Epub 2020 Sep 24.
The incidence of proximal gastric cancer has been increasing continuously. This status has prevailed despite the application of laparoscopic proximal gastrectomy as a surgical treatment for early proximal gastric cancer. The widespread adoption and standardization of this surgical procedure as the primary treatment for the abovementioned cancer has been hampered by the lack of consensus on the optimal reconstruction method after proximal gastrectomy. In addition, the oncological safety of proximal gastrectomy for advanced gastric disease remains unclear. We reviewed the English-language literature to clarify the current status of laparoscopic proximal gastrectomy in proximal gastric cancer. Japanese gastric cancer guidelines have suggested three types of reconstructions for proximal gastrectomy, namely, esophagogastrostomy, double-tract reconstruction, and jejunal interposition. Optimal reconstruction methods remain to be determined because of the lack of adequately performed and well-designed randomized controlled trials. The technical complexity and challenging implementation of reconstruction procedures have resulted in several complications with anastomoses. Multicenter randomized controlled trials are necessary to evaluate the various reconstruction methods and the oncological safety of laparoscopic proximal gastrectomy for advanced gastric disease.
近端胃癌的发病率一直在持续上升。尽管腹腔镜近端胃切除术已被应用于早期近端胃癌的治疗，但这种情况仍然存在。由于缺乏对近端胃切除术后最佳重建方法的共识，这种手术方法的广泛采用和标准化作为上述癌症的主要治疗方法受到了阻碍。此外，对于进展期胃癌，近端胃切除术的肿瘤学安全性仍不清楚。我们回顾了英文文献，以阐明腹腔镜近端胃切除术在近端胃癌中的现状。日本胃癌指南建议了近端胃切除术后的三种重建方法，即食管胃吻合术、双道重建和空肠间置术。由于缺乏充分进行和精心设计的随机对照试验，因此最佳重建方法仍有待确定。由于重建手术的技术复杂性和挑战性，吻合口出现了一些并发症。有必要开展多中心随机对照试验，以评估各种重建方法和腹腔镜近端胃切除术治疗进展期胃癌的肿瘤学安全性。
