第6版日本《胃癌治疗指南》外科治疗部分更新要点解读

2021年7月,日本胃癌学会发布了第6版《胃癌治疗指南》。较第5版更新了9个外科治疗方向的17个相关临床问题。对胃癌微创手术适应证的推荐仍较为谨慎,仅对cⅠ期强推荐腹腔镜下胃远端切除术,对腹腔镜下近端或全胃切除术及机器人手术均为弱推荐。早期胃体癌弱推荐保留幽门的胃切除术,胃上部癌则弱推荐近端胃切除。弱推荐对cT3-T4者行大网膜切除术;对于侵及大弯侧胃上部癌,弱推荐脾切除或脾门淋巴结清扫,但未侵犯胃大弯则强烈不推荐。食管胃结合部癌纵隔淋巴结清扫范围取决于食管浸润长度,即以2 cm或4 cm为界进行评估。因食管胃结合部癌的No.16a2b1的清扫尚存争议,未给出明确推荐。

Interpretation of surgical update in Japanese Gastric Cancer Treatment Guidelines(the 6th edition)

In July 2021, Japanese Gastric Cancer Association(JGCA) published the Version 6 th of Japanese Gastric Cancer Treatment Guidelines. Compared with previous version, surgical update included 9 clinical subject, involving 17 related clinical questions. The Version 6 th guidelines were still cautious in indications of minimally invasive gastrectomy. Only laparoscopy-assisted distal gastrectomy was strongly recommended for cⅠstage, laparoscopy-assisted proximal/total gastrectomy or robotic surgery was weakly recommended. The guidelines weakly recommended pylorus-preserving gastrectomy for early gastric corpus cancer and proximal gastrectomy for proximal gastric cancer. Omentectomy was weakly recommend for cT3-T4 stage. Splenectomy or hilar lymph node dissection was weakly recommended for lesion invading greater curvature, but was strongly not recommended if not invading.Dissection extent of mediastinal lymph node for cT2 + stage esophagogastric junction cancer mainly depended on esophageal invasion length, which was based on the boundary of 2 cm and 4 cm. However, for No. 16 a2 b1, the guidelines couldn’t provide explicit recommendation.