Kelm Matthias, Flemming Sven, Germer Christoph-Thomas, Seyfried Florian
Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland.
Chirurgie (Heidelb). 2025 Apr;96(4):281-287. doi: 10.1007/s00104-024-02198-4. Epub 2024 Dec 6.
The oncological standard for curative treatment of non-metastasized gastric cancer is surgical resection with systematic D2 lymphadenectomy. Early stage carcinomas (pT1a) with circumscribed prerequisites are an exception as they can be endoscopically resected; however, by infiltration of invasive gastric cancer into submucosal layers (pT1b) the risk for lymph node metastases is up to 25-28%. Due to the lack of screening programs in the western world, most gastric cancers are diagnosed in an advanced stage and the treatment is multimodal with perioperative multiple chemotherapy and increasingly more also with immunotherapy. Nevertheless, despite multidisciplinary treatment strategies, the benefits of surgical resection and an adequate systematic lymphadenectomy are still independent prognostic factors for long-term survival; however, the classification and extent of the lymphadenectomy are regularly updated, especially as a result of the spread of minimally invasive operations, and in addition are internationally evaluated differently. In the context of perioperative morbidity and oncological outcome this includes the approach with respect to individual lymph node stations, especially lymph node stations 10 and 12a and in addition the classification D1-D3. Furthermore, continuous modifications, particularly from Asia, such as sentinel lymph node resection underline the pursuit of improvements. The multitude of alterations in the context of multidisciplinary treatment concepts and the international heterogeneity make the evaluation of the value of individual surgical aspects noticeably more difficult.
非转移性胃癌根治性治疗的肿瘤学标准是进行系统性D2淋巴结清扫的手术切除。具备特定条件的早期癌（pT1a）为例外情况，因为它们可通过内镜切除；然而，浸润性胃癌侵犯至黏膜下层（pT1b）时，淋巴结转移风险高达25%-28%。由于西方世界缺乏筛查项目，大多数胃癌在晚期才被诊断出来，治疗方式为多模式，包括围手术期多次化疗，越来越多的还包括免疫治疗。尽管如此，尽管采取了多学科治疗策略，但手术切除和充分的系统性淋巴结清扫的益处仍是长期生存的独立预后因素；然而，淋巴结清扫的分类和范围会定期更新，尤其是由于微创手术的推广，此外国际上对此的评估也有所不同。在围手术期发病率和肿瘤学结果方面，这包括针对各个淋巴结站的处理方法，特别是第10和12a组淋巴结站，此外还有D1-D3分类。此外，持续的改进，特别是来自亚洲的改进，如前哨淋巴结切除，凸显了对改进的追求。多学科治疗理念背景下的众多改变以及国际上的异质性使得评估各个手术方面的价值明显更加困难。
