Tsekrekos Andrianos, Okumura Yasuhiro, Rouvelas Ioannis, Nilsson Magnus
Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery and Oncology, Karolinska Institutet, 141 52 Stockholm, Sweden.
Department of Surgery, University Hospital of Umeå, 907 19 Umeå, Sweden.
Cancers (Basel). 2024 Apr 29;16(9):1741. doi: 10.3390/cancers16091741.
Significant progress has been made in the surgical management of gastric cancer over the years, and previous discrepancies in surgical practice between different parts of the world have gradually lessened. A transition from the earlier period of progressively more extensive surgery to the current trend of a more tailored and evidence-based approach is clear. Prophylactic resection of adjacent anatomical structures or neighboring organs and extensive lymph node dissections that were once assumed to increase the chances of long-term survival are now performed selectively. Laparoscopic gastrectomy has been widely adopted and its indications have steadily expanded, from early cancers located in the distal part of the stomach, to locally advanced tumors where total gastrectomy is required. In parallel, function-preserving surgery has also evolved and now constitutes a valid option for early gastric cancer. Pylorus-preserving and proximal gastrectomy have improved the postoperative quality of life of patients, and sentinel node navigation surgery is being explored as the next step in the process of further refining the minimally invasive concept. Moreover, innovative techniques such as indocyanine green fluorescence imaging and robot-assisted gastrectomy are being introduced in clinical practice. These technologies hold promise for enhancing surgical precision, ultimately improving the oncological and functional outcomes.
多年来，胃癌的外科治疗取得了重大进展，世界各地以往在外科手术实践上的差异已逐渐缩小。从早期越来越广泛的手术方式到当前更具针对性和循证性方法的转变清晰可见。曾经认为可增加长期生存机会的相邻解剖结构或邻近器官的预防性切除以及广泛的淋巴结清扫，现在已选择性地进行。腹腔镜胃切除术已被广泛采用，其适应证也在稳步扩大，从胃远端的早期癌症到需要全胃切除的局部进展期肿瘤。与此同时，保留功能的手术也在不断发展，现已成为早期胃癌的一种有效选择。保留幽门和近端胃切除术改善了患者的术后生活质量，前哨淋巴结导航手术正作为进一步完善微创概念过程中的下一步进行探索。此外，诸如吲哚菁绿荧光成像和机器人辅助胃切除术等创新技术正在临床实践中得到应用。这些技术有望提高手术精度，最终改善肿瘤学和功能结局。
