Shin Ye-Lim, Park Shin-Hoo, Kwon Yeongkeun, Lee Chang Min, Park Sungsoo
Department of Medicine, Korea University College of Medicine, Seoul, Korea.
Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea.
J Minim Invasive Surg. 2021 Dec 15;24(4):175-179. doi: 10.7602/jmis.2021.24.4.175.
Foregut surgery largely involves benign diseases, and not only malignant diseases. However, for foregut surgeons in Asia, this fact has not been extensively utilized in their clinical practice due to the high burden of gastric cancer surgery. Although the prevalence of gastroesophageal reflux disease (GERD) in Eastern Asia, including Korea, is increasing, antireflux surgery (ARS) is still a fairly rare procedure in Korea. ARS is effective as proton pump inhibitors and is cost-effective compared to continuous double-dose proton pump inhibitors in patients with severe GERD. Therefore, we should focus on ARS as a treatment option for GERD also in Asian population. Similarly, although bariatric/metabolic surgery is effective in weight reduction and diabetes mellitus (DM) remission in patients with morbid obesity or DM, bariatric/metabolic surgery is only performed in a limited number of patients. Given that the prevalence of obesity and DM is continuously increasing in Korea, bariatric/metabolic surgery should become an interest among Korean foregut surgeons and should be considered a treatment for obesity and DM. Furthermore, there are new surgical fields that can control both benign and malignant diseases. Oncometabolic surgery is a field under foregut surgery that treats both malignant and benign components of a condition, an example being the control of metabolic syndrome while performing gastric cancer surgery. Therefore, in future gastric cancer treatment, oncometabolic surgery can be applied to patients with gastric cancer accompanied by obesity or metabolic syndrome.
前肠手术主要涉及良性疾病，而非仅恶性疾病。然而，对于亚洲的前肠外科医生而言，由于胃癌手术负担沉重，这一事实在他们的临床实践中并未得到广泛应用。尽管包括韩国在内的东亚地区胃食管反流病（GERD）的患病率在上升，但抗反流手术（ARS）在韩国仍然是一种相当罕见的手术。与质子泵抑制剂一样，ARS对重度GERD患者有效，并且与持续双倍剂量质子泵抑制剂相比具有成本效益。因此，我们也应将ARS作为亚洲人群GERD的一种治疗选择。同样，尽管减重/代谢手术对病态肥胖或糖尿病（DM）患者的体重减轻和糖尿病缓解有效，但仅在有限数量的患者中进行。鉴于韩国肥胖和糖尿病的患病率持续上升，减重/代谢手术应引起韩国前肠外科医生的关注，并应被视为肥胖和糖尿病的一种治疗方法。此外，还有一些新的手术领域可以同时控制良性和恶性疾病。肿瘤代谢手术是前肠手术中的一个领域，可治疗疾病的恶性和良性成分，例如在进行胃癌手术时控制代谢综合征。因此，在未来的胃癌治疗中，肿瘤代谢手术可应用于伴有肥胖或代谢综合征的胃癌患者。
