腹腔镜根治手术在胃癌中应用的现状与争议

我国胃癌治疗效果仍不容乐观，我中心近年来由于规范的手术质量控制，胃癌尤其进展期Ⅲ期胃癌的治疗效果得到很大提高。全球多中心大样本的临床研究已明确了腹腔镜胃癌根治术治疗早期胃癌的安全性和有效性，中国和日本先后将腹腔镜手术确定为临床I期远端胃癌的推荐术式。腹腔镜根治手术治疗进展期胃癌，手术难度大、学习曲线长。目前，中国、日本和韩国等开展了多项临床研究评价腹腔镜根治手术治疗进展期胃癌的可行性、有效性，有望证实其长期疗效。随着手术技术进步、手术步骤优化、手术操作进一步熟练，腹腔镜根治手术治疗胃癌的适应证将不断扩大。腹腔镜手术可完成常规的淋巴结清扫，有经验的中心甚至可完成扩大清扫及脉络化清扫。进展期胃癌根治手术网膜囊切除存有争议，掌握技术，腹腔镜下网膜囊切除安全、可行，本文总结分享了我中心腹腔镜下胃癌根治网膜囊切除的经验。随着腹腔镜手术技术和设备的发展，以及经验的积累，腹腔镜手术在保证其安全性的前提下，完全可达到与开腹手术相当的根治程度。对于腹腔镜根治手术存在的争议，需开展相应的临床研究，以期进一步阐明腹腔镜根治手术在胃癌治疗中的优劣。

Current Status and Controversy of Laparoscopic Radical Gastrectomy for Gastric Cancer

The surgical treatment effect of gastric cancer is still dissatisfactory in China. Great progress has been made in clinical outcome of gastric cancer after surgical treatment, esp. advanced stage Ⅲ cancer because of high surgical quality control in our center. The safety and effectiveness of laparoscopic radical gastrectomy for early gastric cancer has been confirmed by many large scale, multi-center clinical trials. Laparoscopic radical resection was recommended as the optional treatment for clinical stage I distal gastric cancer in China and Japan. Laparoscopic radical resection for advanced gastric cancer remained some limitations including surgical difficulty in lymphadenectomy, radical extent and long learning curve. More clinical trials were being carried out to confirm the feasibility, effectiveness and long-term survival of laparoscopic radical resection for advanced gastric cancer in China, Japan and Korea. With the development of surgical technique, further optimization of surgical procedures, proficiency of surgical operation, the indications of laparoscopic radical resection for advanced gastric cancer would be expanded. Laparoscopic surgery could achieve routine lymphadenectomy, or extended and even skeletonized lymphadenectomy in some large volume specialties. The role of bursectomy for advanced gastric cancer is still controversial. Laparoscopic bursectomy was safe and feasible if performed by experienced surgeons. This article also summarized our experience of laparoscopic bursectomy for advanced gastric cancer. With the development of laparoscopic surgery technology and equipments, as well as the experience accumulation and proficiency of surgical operation, laparoscopic surgery could achieve safety and the same radical extent compared with open surgery. It is necessary to carry out relevant clinical studies to further elaborate the advantages and disadvantages of laparoscopic surgery in the treatment of gastric cancer.