腹腔镜探查对进展期胃癌精准分期的临床意义

doi:10.16139/j.1007-9610.2022.04.019

摘要/Abstract

摘要：

胃癌严重威胁人类健康,超过70%的初诊病人已属进展期或伴转移。目前存在“三高”现象:进展期胃癌比例高,不必要的剖腹探查率偏高,以及非R0切除率偏高。腹腔镜探查可发现:①腹腔内隐匿、影像学检查无法诊断的微小转移病灶;②明确已侵犯邻近脏器;③通过腹腔灌洗发现腹腔游离癌细胞,从而精准分期以确定合理的治疗方案。明确T_4b分期,采取积极的术前治疗。发现腹腔隐匿性转移灶,避免过度治疗。筛查脱落细胞,实施转化治疗。选择合适的新辅助治疗,进一步改善胃癌病人的预后。

关键词: 胃癌, 腹腔镜探查, 腹腔转移, 临床分期

Abstract:

Gastric cancer is the leading cause of cancer-related deaths in human. More than 70% patients present with advanced gastric cancer or with metastasis in clinic. There are three “higher ratio” of phenomenons at present includ-ing higher ratio of advanced gastric cancer, higher ratio of unnecessary laparotomy, and higher ratio of non-R0 radical gastrectomy. Diagnostic laparoscopy can be used: ① to discover occult and micro enough metastatic lesions in the abdo-minal cavity which could not be diagnosed by current imaging examinations; ② to determine whether gastric cancer invaded adjacent organs; ③ to identify intraperitoneal free cancer cells using peritoneal lavage. Then the precision staging would be gotten for reasonable treatment strategy. T_4b stage is diagnosed for positive preoperative treatment. Intraperitoneal occult metastatic lesions are found to avoid unnecessary gastrectomy. Separate cancer cells are screened for conversion therapy. The prognosis of patients with gastric cancer could be improved further when the neoadjuvant therapy is selected.

Key words: Gastric cancer, Laparoscopic exploration, Abdominal metastasis, Clinical staging

中图分类号:

R735.2

聂明明, 朱正纲. 腹腔镜探查对进展期胃癌精准分期的临床意义[J]. 外科理论与实践, 2022, 27(04): 365-370.

NIE Mingming, ZHU Zhenggang. Clinical significance of diagnostic laparoscopy on precision staging in advanced gastric cancer[J]. Journal of Surgery Concepts & Practice, 2022, 27(04): 365-370.

参考文献 35

[1]	GBD 2017 Stomach Cancer Collaborators The global, regional, and national burden of stomach cancer in 195 countries, 1990-2017: a systematic analysis for the Glo-bal Burden of Disease study 2017[J]. Lancet Gastroenterol Hepatol,2020, 5(3):42-54. doi: 10.1016/S2468-1253(19)30328-0 URL
[2]	Digklia A, Wagner AD. Advanced gastric cancer: current treatment landscape and future perspectives[J]. World J Gastroenterol, 2016, 22(8):2403-2414. doi: 10.3748/wjg.v22.i8.2403 URL
[3]	中国胃肠肿瘤外科联盟. 中国胃肠肿瘤外科联盟数据报告(2014—2016)[J]. 中国实用外科杂志,2018, 38(1):90-93.
[4]	Honma Y, Terauchi T, Tateishi U, et al. Imaging peritoneal metastasis of gastric cancer with ¹⁸F-fluorothymidine positron emission tomography/computed tomography: a proof-of-concept study[J]. Br J Radiol, 2018, 91(1089):20180259.
[5]	Ramos RF, Scalon FM, Scalon MM, et al. Staging laparoscopy in gastric cancer to detect peritoneal metastases: a systematic reviewand meta-analysis[J]. Eur J Surg Oncol, 2016, 42(9):1315-1321. doi: 10.1016/j.ejso.2016.06.401 pmid: 27432515
[6]	Yamagata Y, Awmikura K, Kawashima Y, et al. Staging laparoscopy in advanced gastric cancer: usefulness and issues requiring improvement[J]. Hepato-Gastroenterology, 2013, 60(124):751-755.
[7]	Coburn N, Cosby R, Klein L, et al. Staging and surgical approaches in gastric cancer: a clinical practice guideline[J]. Curr Oncol, 2017, 24(5):324-331. doi: 10.3747/co.24.3736 pmid: 29089800
[8]	Ikoma N, Blum M, Chiang YJ, et al. Yield of staging laparoscopy and lavage cytology for radiologically occult peritoneal carcinomatosis of gastric cancer[J]. Ann Surg Oncol, 2016, 23(13):4332-4337. doi: 10.1245/s10434-016-5409-7 URL
[9]	Borgstein ABJ, van Berge Henegouwen MI, Lameris W, et al. Staging laparoscopy in gastric cancer surgery. a population-based cohort study in patients undergoing gastrectomy with curative intent[J]. Eur J Surg Oncol, 2021, 47(6):1441-1448. doi: 10.1016/j.ejso.2020.11.011 URL
[10]	Hu YF, Deng ZW, Liu H, et al. Staging laparoscopy improves treatment decision-making for advanced gastric cancer[J]. World J Gastroenterol, 2016, 22(5):1859-1868. doi: 10.3748/wjg.v22.i5.1859 URL
[11]	李豪杰, 张启, 陈凌, 等. 诊断性腹腔镜对于胃癌治疗策略选择的意义[J]. 中华胃肠外科杂志, 2017, 20(2):195-199.
[12]	Leake PA, Cardoso R, Seevaratnam R, et al. A systema-tic review of the accuracy and indications for diagnostic laparoscopy prior to curative-intent resection of gastric cancer[J]. Gastric Cancer, 2012, 15 Suppl 1:S38-S47.
[13]	陕飞, 李子禹, 张连海, 等. 国际抗癌联盟及美国肿瘤联合会胃癌TNM分期系统(第8版)简介及解读[J]. 中国实用外科杂志, 2017, 37(1):15-18.
[14]	Amin MB, Edge SB, Greene FL, et al. American Joint Commission on Cancer cancer staging manual[M]. 8th ed. NewYork: Springer,2017.
[15]	Borgstein ABJ, van Berge Henegouwen MI, Lameris W, et al. Staging laparoscopy in gastric cancer surgery. a population-based cohort study in patients undergoing gastrectomy with curative intent[J]. Eur J Surg Oncol, 2021, 47(6):1441-1448. doi: 10.1016/j.ejso.2020.11.011 URL
[16]	Muntean V, Mihailov A, Iancu C, et al. Staging laparoscopy in gastric cancer. accuracy and impact on therapy[J]. J Gastrointestin Liver Dis, 2009, 18(2):189-195.
[17]	Zech CJ, Korpraphong P, Huppertz A, et al. Randomized multicentre trial of gadoxetic acid-enhanced MRI versus conventional MRI or CT in the staging of colorectal cancer liver metastases[J]. Br J Surg, 2014, 101(6):613-621. doi: 10.1002/bjs.9465 pmid: 24652690
[18]	朱正纲. 胃癌腹膜转移转化性治疗的临床意义和实践要点[J]. 中华胃肠外科杂志, 2017, 20(10):1094-1097.
[19]	Burbidge S, Mahadya K, Naik K. The role of CT and staging laparoscopy in the staging of gastric cancer[J]. Clin Radiol, 2013, 68(3):251-255. doi: 10.1016/j.crad.2012.07.015 pmid: 22985749
[20]	Badgwell B, Das P, Ajani J. Treatment of localized gastric and gastroesophageal adenocarcinoma: the role of accurate staging and preoperative therapy[J]. J Hematol Oncol, 2017, 10(1):149-155. doi: 10.1186/s13045-017-0517-9 URL
[21]	Fujitani K, Yang HK, Mizusawa J, et al. Gastrectomy plus chemotherapy versus chemotherapyalone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial[J]. Lancet Oncol, 2016, 17(3):309-318. doi: 10.1016/S1470-2045(15)00553-7 URL
[22]	Fukagawa T. Role of staging laparoscopy for gastric cancer patients[J]. Ann Gastroenterol Surg, 2019, 3(5):496-505. doi: 10.1002/ags3.12283 pmid: 31549009
[23]	Irino T, Sano T, Hiki N, et al. Diagnostic staging laparoscopy in gastric cancer: a prospective cohort at a cancer institute in Japan[J]. Surg Endosc, 2018, 32(1):268-275. doi: 10.1007/s00464-017-5673-z URL
[24]	Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition)[J]. Gastric Cancer,2021, 24(1):1-21. doi: 10.1007/s10120-020-01042-y URL
[25]	中国抗癌协会胃癌专业委员会. 胃癌诊治难点中国专家共识(2020版)[J]. 中国实用外科杂志, 2020, 40(8):869-904.
[26]	Ramos RF, Scalon FM, Scalon MM, et al. Staging laparoscopy in gastric cancer to detect peritoneal metastases: a systematic review and meta-analysis[J]. Eur J Surg Oncol, 2016, 42(9):1315-1321. doi: 10.1016/j.ejso.2016.06.401 pmid: 27432515
[27]	Lee SD, Ryu KW, Eom BW, et al. Prognostic significance of peritoneal washing cytology in patients with gastric cancer[J]. Br J Surg, 2012, 99(3):397-403. doi: 10.1002/bjs.7812 pmid: 22101572
[28]	Nashimoto A, Akazawa K, Isobe Y, et al. Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry[J]. Gastric Cancer,2013, 16(1):1-27. doi: 10.1007/s10120-012-0163-4 URL
[29]	Fukagawa T, Katai H, Saka M, et al. Significance of lavage cytology in advanced gastric cancer patients[J]. World J Surg, 2010, 34(3):563-568. doi: 10.1007/s00268-009-0355-1 pmid: 20054543
[30]	Ishigami H, Yamaguchi H, Yamashita H, et al. Surgery after intraperitoneal and systemic chemotherapy for gastric cancer with peritoneal metastasis or positive peritoneal cytology findings[J]. Gastric Cancer, 2017, 20 (Suppl 1):S128-S134.
[31]	Yasufuku I, Nunobe S, Ida S, et al. Conversion therapy for peritoneal lavage cytology-positive type 4 and large type 3 gastric cancer patients selected as candidates for R0 resection by diagnostic staging laparoscopy[J]. Gastric Cancer, 2019, 15(3):335-337. doi: 10.1007/s10120-012-0156-3 URL
[32]	Miki Y, Tokunaga M, Tanizawa Y, et al. Staging laparoscopy for patients with cM0, type 4, and large type 3 gastric cancer[J]. World J Surg, 2015, 39(11):2742-2747. doi: 10.1007/s00268-015-3144-z URL
[33]	Li K, Cannon JGD, Jiang SY, et al. Diagnostic staging laparoscopy in gastric cancer treatment: a cost-effectiveness analysis[J]. J Surg Oncol, 2018, 117(6):1288-1296. doi: 10.1002/jso.24942 URL
[34]	Brenkman HJF, Gertsen EC, Vegt E, et al. Evaluation of PET and laparoscopy in STagIng advanced gastric cancer: a multicenter prospective study(PLASTIC-study)[J]. BMC Cancer, 2018, 18(1):1-7. doi: 10.1186/s12885-017-3892-2 URL
[35]	Li ZY, Li ZM, Zhang LH, et al. Staging laparoscopy for locally advanced gastric cancer in Chinese patients: a multicenter prospective registry study[J]. BMC Cancer, 2018, 18(1):63-66. doi: 10.1186/s12885-017-3791-6 URL