Narayan Raja R, Poultsides George A
Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Transl Gastroenterol Hepatol. 2021 Jan 5;6:16. doi: 10.21037/tgh.2020.02.06. eCollection 2021.
Since Theodore Billroth and Cesar Roux perfected the methods of post-gastrectomy reconstruction in the late 19 century, surgical management of gastric and gastroesophageal cancer has made incremental progress. The majority of patients with localized disease are treated with perioperative combination chemotherapy or neoadjuvant chemoradiation. Staging laparoscopy before initiation of treatment or before surgical resection has improved staging accuracy and can drastically inform treatment decisions. The longstanding and contentious debate on the optimal extent of lymph node dissection for gastric cancer appears to have settled in favor of D2 dissection with the recently published 15-year follow-up of the Dutch randomized trial. Minimally invasive gastric and gastroesophageal resections are performed routinely in most centers affording faster recovery and equivalent oncologic outcomes. Pylorus-preserving distal (central) gastrectomy has emerged as a less invasive, function-preserving option for T1N0 middle-third gastric cancers, while randomized data on its oncologic adequacy are pending. Multi-visceral resections and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy has been utilized selectively for patients with locally advanced tumors who have demonstrated disease control on preoperative chemotherapy. This review summarizes the current standard of surgical care for gastroesophageal junction and gastric cancer as well as highlights recent and upcoming advances to the field.
自19世纪末西奥多·比尔罗特（Theodore Billroth）和塞萨尔·鲁（Cesar Roux）完善了胃切除术后重建方法以来，胃癌和胃食管癌的外科治疗取得了渐进式进展。大多数局限性疾病患者接受围手术期联合化疗或新辅助放化疗。在开始治疗或手术切除前进行分期腹腔镜检查提高了分期准确性，并能极大地为治疗决策提供依据。关于胃癌最佳淋巴结清扫范围的长期且有争议的争论似乎已尘埃落定，荷兰随机试验最近公布的15年随访结果支持D2清扫。大多数中心常规进行微创胃癌和胃食管癌切除术，能实现更快恢复且肿瘤学结局相当。保留幽门的远端（中部）胃切除术已成为T1N0中三分之一胃癌侵袭性较小、保留功能的选择，但其肿瘤学充分性的随机数据尚未得出。多脏器切除术和热灌注化疗的细胞减灭术已被选择性地用于术前化疗显示疾病得到控制的局部晚期肿瘤患者。本综述总结了胃食管交界部癌和胃癌的当前外科治疗标准，并强调了该领域最近及即将取得的进展。
