腹腔内常温与全身联合治疗胃癌腹膜转移的亚洲专家共识

doi:10.16139/j.1007-9610.2025.04.01

外科理论与实践 ›› 2025, Vol. 30 ›› Issue (04): 277-294.doi: 10.16139/j.1007-9610.2025.04.01

• 指南与共识 • 下一篇

腹腔内常温与全身联合治疗胃癌腹膜转移的亚洲专家共识

朱正纲^1a^,^*(), 北山丈二²^,^*, 金炯浩³^,^*, 苏博仁⁴^,^*, 曹晖⁵, 陈凛⁶, 程向东⁷, 胡建昆⁸, 今野元博⁹, 石神浩德¹⁰, 池艺燮¹¹, 金钟汉¹², 小寺泰弘¹³, 梁寒¹⁴, 刘晓文¹⁵, 陆晟^1a, 牟一平¹⁶, 聂明明¹⁷, 徐元俊¹⁸, 王亚农¹⁵, 吴丹¹⁹, 徐则宽²⁰, 山口博纪²¹, 严超^1a, 杨中印^1a, 印慨¹⁷, 米村豊²², 杨伟鹏²³, 于吉人²⁴, 张俊^1b, 亚洲胃癌NIPS治疗协作组^1b, 上海市抗癌协会腹膜肿瘤专业委员会^1b

1.上海交通大学医学院附属瑞金医院 a.普外科，上海消化外科研究所，上海胃肿瘤重点实验室，b. 肿瘤科，上海 200025
2.日本自治医科大学，自治医科大学医院临床研究中心消化外科，日本栃木县下野市
3.首尔大学盆唐医院外科，韩国城南市，首尔大学医学院，韩国首尔市
4.新加坡国立大学，新加坡国立大学医院外科，新加坡
5.上海交通大学医学院附属仁济医院普外科，上海 200127
6.北京大学国际医院普外科，北京 102206
7.浙江省肿瘤医院浙江省上消化道肿瘤诊治技术研发中心, 浙江杭州 310022
8.四川大学华西医院胃肠外科胃癌研究室，四川成都 610041
9.日本近畿大学医学部外科，日本大阪府东大阪市
10.东京大学医学部附属医院化疗科，东京大学医学研究生院消化外科，日本东京都文京区
11.檀国大学医院外科，檀国大学医学院，韩国天安市
12.高丽大学九老医院外科，高丽大学医学院，韩国首尔市
13.名古屋大学医学研究生院胃肠外科，日本名古屋市
14.天津医科大学肿瘤医院胃部肿瘤科，天津 300060
15.复旦大学附属肿瘤医院胃肿瘤科复旦大学上海医院院肿瘤学系，上海 200032
16.浙江省人民医院胃肠胰外科，浙江杭州 310014
17.海军军医大学附属长海医院普外科，上海 200433
18.高丽大学医学院上消化道外科，韩国首尔市
19.浙江大学医学院附属第二医院普外科，浙江杭州 310009
20.江苏省人民医院南京医科大学第一附属医院普外科，江苏南京 210029
21.日本自治医科大学外科临床肿瘤学分部，日本栃木县下野市
22.日本岸和田德洲会医院腹膜播散中心，日本大阪府岸和田市
23.新加坡国立大学癌症中心血液肿瘤科，新加坡
24.浙江大学医学院附属第一医院胃肠外科，浙江杭州 310003

收稿日期:2025-07-10 出版日期:2025-07-25 发布日期:2025-10-23
通讯作者: 朱正纲，E-mail： zzg1954@hotmail.com
作者简介:第一联系人：^*共同第一作者；其余作者按姓氏字母顺序排列。

Asian consensus on normothermic intraperitoneal and systemic treatment for gastric cancer with peritoneal metastasis

ZHU Zhenggang^1a^,^*(), Joji Kitayama²^,^*, Hyung-Ho Kim³^,^*, Jimmy Bok-Yan So⁴^,^*, CAO Hui⁵, CHEN Lin⁶, CHENG Xiangdong⁷, HU Jiankun⁸, Motohiro Imano⁹, Hironori Ishigami¹⁰, Ye Seob Jee¹¹, Jong-Han Kim¹², Yasuhiro Kodera¹³, LIANG Han¹⁴, LIU Xiaowen¹⁵, LU Sheng^1a, MOU Yiping¹⁶, NIE Mingming¹⁷, Won Jun Seo¹⁸, WANG Yanong¹⁵, WU Dan¹⁹, XU Zekuan²⁰, Hironori Yamaguchi²¹, YAN Chao^1a, YANG Zhongyin^1a, YIN Kai¹⁷, Yutaka Yonemura²², Wei-Peng Yong²³, YU Jiren²⁴, ZHANG Jun^1b, Asian Gastric Cancer NIPS Treatment Collaborative Group^1b, Shanghai Anticancer Association, Committee of Peritoneal Tumor^1b

1a. Department of General Surgery, Shanghai Institute of Digestive Surgery, Shanghai Key Laboratory of Gastric Neoplasms, b. Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
2. Department of Gastrointestinal Surgery, Clinical Research Center, Jichi Medical University, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
3. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea, Seoul National University College of Medicine, Seoul, Korea
4. Department of Surgery, National University Hospital, National University of Singapore, Singapore
5. Department of General Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
6. Department of General Surgery, Peking University International Hospital, Beijing 102206, China
7. Zhejiang Provincial Research Center for Upper Gastrointestinal Tract Cancer, Zhejiang Cancer Hospital, Zhejiang Hangzhou 310022, China
8. Department of Gastrointestinal Surgery, Laboratory of Gastric Cancer, West China Hospital, Sichuan University, Sichuan Chengdu 610041, China
9. Department of Surgery, Faculty of Medicine, Kindai University, Higashiosaka, Osaka, Japan
10. Department of Chemotherapy, The University of Tokyo Hospital, Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
11. Department of Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
12. Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
13. Department of Gastroenterological Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
14. Department of Gastric Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin 300060, China
15. Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
16. Department of Gastroenterology & Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Zhejiang Hangzhou 310014, China
17. Department of General Surgery, Shanghai Changhai Hospital, Naval Medical University, Shanghai 200433, China
18. Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
19. Department of General Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Hangzhou 310009, China
20. Department of General Surgery, Jiangsu Province Hospital, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Nanjing 210029, China
21. Department of Surgery, Division of Clinical Oncology, Jichi Medical University, Shimotsuke, Tochigi, Japan
22. Peritoneal Dissemination Center, Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan
23. Department of Haematology-Oncology, National University Cancer Institute, Singapore
24. Department of Gastrointestinal Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Hangzhou 310003, China

Received:2025-07-10 Online:2025-07-25 Published:2025-10-23

摘要/Abstract

摘要：

胃癌腹膜转移（GCPM）是进展期胃癌常见且致死性高的并发症，中位生存期仅5~11个月。本共识由亚洲30位专家（中国、日本、韩国、新加坡）采用德尔菲法和GRADE证据分级制定，共29条声明，涵盖GCPM诊断评估、腹腔镜探查与NIPS（normothermic intraperitoneal and systemic treatment）适应证、治疗方案、并发症预防管理、转化手术指征及术后腹腔治疗等。共识旨在规范临床实践，提高GCPM预后。

关键词: 胃癌, 腹膜转移, 腹腔内常温化疗, 腹腔内联合全身化疗, 转化手术, 共识

Abstract:

Gastric cancer with peritoneal metastasis (GCPM) is a common and lethal manifestation of advanced gastric cancer, with a median survival of only 5-11 months. This consensus was developed by 30 experts from Asia (China, Japan, Korea, and Singapore) using the Delphi method and the GRADE evidence grading system. A total of 29 statements were formulated, covering the diagnosis and assessment of GCPM, indications for laparoscopic exploration and NIPS (normothermic intraperitoneal and systemic treatment), treatment regimens, prevention and management of complications, criteria for conversion surgery, and postoperative intraperitoneal therapy. The consensus aims to standardize clinical practice and improve the prognosis of patients with GCPM.

Key words: Gastric cancer, Peritoneal metastasis(PM), Normothermic intraperitoneal chemotherapy, Intraperitoneal and systemic chemotherapy, Conversion surgery, Consensus

中图分类号:

R735.2

朱正纲, 北山丈二, 金炯浩, 苏博仁, 曹晖, 陈凛, 程向东, 胡建昆, 今野元博, 石神浩德, 池艺燮, 金钟汉, 小寺泰弘, 梁寒, 刘晓文, 陆晟, 牟一平, 聂明明, 徐元俊, 王亚农, 吴丹, 徐则宽, 山口博纪, 严超, 杨中印, 印慨, 米村豊, 杨伟鹏, 于吉人, 张俊, 亚洲胃癌NIPS治疗协作组, 上海市抗癌协会腹膜肿瘤专业委员会. 腹腔内常温与全身联合治疗胃癌腹膜转移的亚洲专家共识[J]. 外科理论与实践, 2025, 30(04): 277-294.

ZHU Zhenggang, Joji Kitayama, Hyung-Ho Kim, Jimmy Bok-Yan So, CAO Hui, CHEN Lin, CHENG Xiangdong, HU Jiankun, Motohiro Imano, Hironori Ishigami, Ye Seob Jee, Jong-Han Kim, Yasuhiro Kodera, LIANG Han, LIU Xiaowen, LU Sheng, MOU Yiping, NIE Mingming, Won Jun Seo, WANG Yanong, WU Dan, XU Zekuan, Hironori Yamaguchi, YAN Chao, YANG Zhongyin, YIN Kai, Yutaka Yonemura, Wei-Peng Yong, YU Jiren, ZHANG Jun, Asian Gastric Cancer NIPS Treatment Collaborative Group, Shanghai Anticancer Association, Committee of Peritoneal Tumor. Asian consensus on normothermic intraperitoneal and systemic treatment for gastric cancer with peritoneal metastasis[J]. Journal of Surgery Concepts & Practice, 2025, 30(04): 277-294.

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证据级别
A（强）	效果的期望值有很强的可靠性
B（中）	效果的期望值有中等强度的可靠性
C（弱）	效果的期望值可靠性有限
D（很弱）	效果的期望值几乎无可靠性

腹腔内治疗	全身治疗
紫杉醇20 mg/m²，第1、8天	静脉紫杉醇50 mg/m²，第1、8天+口服S-1 40 mg/m² ，每天2次，第1~14天[PS（紫杉醇＋S-1）]方案^[10,85]
紫杉醇20 mg/m²，第1、8、22天	静脉顺铂60 mg/m²，第8天+口服S-1 40 mg/m²，每天2次，第1~14天（SP方案）^[52]
紫杉醇40~80 mg/m²，第1、8天	静脉奥沙利铂100 mg/m²，第1天+口服S-1 40 mg/m²，每天2次，第1~14天（SOX方案）^[65]
紫杉醇40 mg/m²，第1、8天	静脉奥沙利铂100 mg/m²，第1天+口服卡培他滨1 000 mg/m²，每天2次，第1~14天（CAPEOX方案）^[96]
紫杉醇60 mg/m²，第1天	静脉奥沙利铂100 mg/m²，第1天+静脉亚叶酸钙100 mg/m²，第1天+静脉氟尿嘧啶100 mg/m²，第1天（FOLFOX方案）^[54]
紫杉醇80 mg/m²，第1天	静脉奥沙利铂100 mg/m²，第1天+口服S-1 40 mg/m²，每天2次，第1~14天（SOX方案）^[97]
紫杉醇80 mg/m²，第1、8天	静脉紫杉醇50 mg/m²，第1、8天+口服S-1 40 mg/m²，每天2次，第1~14天（PS方案）^[92]
多西他赛40~60 mg/m²，第1、8天	口服S-1 40 mg/m²，每天2次，第1~14天^[93]
多西他赛35~50 mg/m²，第1、15天	口服S-1 40 mg/m²，每天2次，第1~14天^[98]
顺铂30 mg/m²，第1天+多西他赛30 mg/m²，第1天	口服S-1 30 mg/m²，每天2次，第1~14天^[99]

腹腔内常温与全身联合治疗胃癌腹膜转移的亚洲专家共识

Asian consensus on normothermic intraperitoneal and systemic treatment for gastric cancer with peritoneal metastasis

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