Background

Gastric adenocarcinoma accounted for 6.8% of new cancer cases and 8.8% of cancer deaths worldwide in 2012. Although resection is the cornerstone for cure, several aspects of surgical intervention remain controversial or sub-optimally applied at the population level. These include staging, extent of lymph node dissection (LND), optimal requirements of LN assessment, minimum resection margins, surgical technique (laparoscopic vs. open), relationship between surgical volumes and patient outcomes, and resection of stage IV gastric cancer.

Methods

A systematic review was conducted to inform surgical care.

Results

The evidence included in this systematic review consists of one guideline, seven systematic reviews and 48 primary studies.

Conclusions

All patients should be discussed at a multidisciplinary team meeting and a staging CT of the chest and abdomen should always be performed. Diagnostic laparoscopy should be performed in patients at risk for stage IV disease. A D2 LND is preferred for curative-intent resection in advanced non-metastatic gastric cancer. At least 16 LNs should be assessed for adequate staging of curative-resected gastric cancer. Gastric cancer surgery should aim to achieve an RO resection margin. In the metastatic setting, surgery should only be considered for palliation of symptoms. Patients should be referred to higher volume centres, and those with adequate support to manage potential complications. Laparoscopic resections should be performed to the same standards as open resections.

中文翻译：

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胃癌的分期和手术方法：系统评价

背景

2012年，胃腺癌在全球新发癌症病例中占6.8％，在癌症死亡中所占的比例为8.8％。尽管切除是治愈的基石，但在人群水平上，外科手术的若干方面仍存在争议或欠佳。这些包括分期，淋巴结清扫范围（LND），LN评估的最佳要求，最小切除余量，手术技术（腹腔镜与开放式），手术量与患者预后之间的关系以及IV期胃癌的切除。

方法

进行了系统的审查，以告知外科护理。

结果

这项系统评价中包括的证据包括一项指南，七项系统评价和48项基础研究。

结论

应在多学科小组会议上讨论所有患者，并应始终进行胸部和腹部的CT分期检查。对有IV期疾病风险的患者应进行诊断性腹腔镜检查。对于晚期非转移性胃癌的根治性切除，首选D2 LND。至少应评估16个LN，以进行治疗性切除的胃癌的充分分期。胃癌手术应旨在实现RO切除余量。在转移性情况下，仅应考虑减轻症状。应将患者转诊至较高容量的中心，并应将其转介至有足够支持以处理潜在并发症的患者。腹腔镜切除术应按照与开放切除术相同的标准进行。