新辅助治疗时代对胃癌外科发展趋势的影响与思考  

The impact and reflection on the development trend of surgery for gastric cancer in the era of neoadjuvant therapy

作　　者：白飞[1] 王伟[2] 李胜 Bai Fei;Wang Wei;Li Sheng(Department of Gastroduodenal and Pancreatic Surgery,Hunan Cancer Hospital,Changsha 410013,Hunan,China;Department of Gastroenterology and Urology I,Hunan Cancer Hospital,Changsha 410013,Hunan,China;Department of Gastrointestinal Surgery,the Central Hospital of Shaoyang,Shaoyang 422000,Hunan,China)

机构地区：[1]湖南省肿瘤医院完胃十二指肠胰腺外科,湖南长沙410013 [2]湖南省肿瘤医院消化泌尿内二科,湖南长沙410013 [3]邵阳市中心医院胃肠外科,湖南邵阳422000

出　　处：《消化肿瘤杂志(电子版)》2025年第1期34-40,共7页Journal of Digestive Oncology(Electronic Version)

基　　金：湖南省创新型省份建设专项经费资助项目(2023SK4089)。

摘　　要：胃癌的发病率在我国恶性肿瘤中排名第五,死亡率位居第三。新辅助治疗已成为局部进展期胃癌术前的标准治疗手段,它可以使肿瘤缩退,提高RO切除率,减少局部复发和远处转移,改善患者预后。临床上我们时常会遇到胃癌患者在接受新辅助治疗后,部分病例获得临床或病理完全缓解。这时我们面临一个现实的问题,这些病例是否可以缩小手术范围,甚至选择等待观察的策略?特别是当患者对保留器官要求很高的时候,外科医生是否可以去尝试?目前这些问题都是很值得探究的,也是临床医生最为关注的焦点问题。本文结合现有循证医学证据,就上述临床问题进行探讨。本文将为未来接受新辅助治疗的胃癌患者在确保肿瘤学疗效的前提下,是否缩小手术范围或等待观察提供思路,期待起到抛砖引玉的作用。The incidence of gastric cancer ranks fifth among malignant tumors in China,while its mortality rate ranks third.Neoadjuvant therapy has become standard preoperative treatment for locally advanced gastric cancer,which can cause tumor regression,increase the RO resection rate,reduce local recurrence and distant metastasis,and improve the prognosis of patients.In clinical practice,we often encounter cases of gastric cancer who achieve clinical or pathological complete response after neoadjuvant therapy.There is a practical question at this time:Whether the extent of surgery could be reduced or even a watch and wait strategy be adopted for these cases?Can surgeons attempt to do it especially when patients have a high demand for organ preservation?Currently,these issues are highly worthy of exploration and are the most concerning focus for clinicians.This article discusses the above clinical issues based on existing evidence-based medicine.It will also provide ideas for reducing the extent of surgery or watch and wait under the premise of ensuring oncological safety for gastric cancer after neoadjuvant therapy in the future,and hopes to play a role in stimulating further discussion.

关 键 词：胃癌 新辅助治疗 手术范围 等待观察 外科手术 

分 类 号：R73[医药卫生—肿瘤]