免疫治疗时代胃癌手术范围与功能保存的合理选择  

Reasonable selection of surgical range and functional preservation for gastric cancer in the era of immunotherapy

作　　者：赵恩昊[1] 曹晖[1] ZHAO En-hao;CAO Hui(Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,上海200127

出　　处：《中国实用外科杂志》2024年第10期1125-1129,共5页Chinese Journal of Practical Surgery

基　　金：上海市“科技创新行动计划”自然科学基金项目(No.23ZR1439400)。

摘　　要：随着免疫治疗时代的来临,局部进展期胃癌采用免疫治疗联合化疗的围手术期治疗策略也从探索尝试逐步到开展相关临床研究,并取得一定成果,尽管现阶段的临床研究在远期生存方面并未得到阳性结果,但对于病理缓解和降期的效果已充分体现。因此,对于传统胃癌手术的原发病灶切除和区域淋巴结清扫的根治性原则是否可加以挑战,则更加引发深思。通过术前精准诊断选择合适病人,在转移淋巴结准确辨识基础上,实施原发病灶的切除以及精准的转移淋巴结或区域淋巴结清扫,进而保存更多的未受累淋巴结,以维持T细胞活性和针对肿瘤细胞的特异性杀伤功能,并优化手术径路和最大程度上保留胃的解剖和生理功能,在确保肿瘤学安全性的前提下,更好地改善病人的生活质量。With the advent of the era of immunotherapy,perioperative treatment of locally advanced gastric cancer using immunotherapy combined with chemotherapy has gradually changed from exploratory attempts to relevant clinical trials,and certain results have been achieved.Although the clinical trials at this stage have not obtained positive results in terms of long-term survival,the effects on pathological response and downstaging have been fully reflected.Therefore,whether the radical principles of primary lesion resection and regional lymph node dissection in traditional gastric cancer surgery can be challenged is more thought-causing.Appropriate patients were selected through accurate preoperative diagnosis,and on the basis of accurate identification of metastatic lymph nodes,primary lesion resection and accurate metastatic lymph node dissection or regional lymph node dissection were performed,so as to save more uninvolved lymph nodes to maintain T cell activity and specific killing function against tumor cells,and optimize the surgical approach and preserve the anatomical and physiological functions of the stomach to the greatest extent.Under the premise of ensuring the oncological safety,better improve the quality of life of patients.

关 键 词：胃癌 新辅助治疗 免疫治疗 淋巴结清扫 功能保存 

分 类 号：R6[医药卫生—外科学]