Journal of Surgery Concepts & Practice ›› 2023, Vol. 28 ›› Issue (04): 326-354.doi: 10.16139/j.1007-9610.2023.04.010
• Consensus and guidelines • Previous Articles Next Articles
YAN Chao, LU Sheng*, YAN Min, ZHU Zhenggang(
)
Received:2023-01-17
Online:2023-07-25
Published:2023-10-24
CLC Number:
YAN Chao, LU Sheng, YAN Min, ZHU Zhenggang. Chinese interpretation of Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition) and Ruijin clinical practice[J]. Journal of Surgery Concepts & Practice, 2023, 28(04): 326-354.
Fig 1
Algorithm of standard treatments
Fig 2
Algorithm of standard treatments in Ruijin Hospital
Fig 3
Lymph node dissection in total gastrectomy Lymph node stations in blue need to be dissected in D1 dissection. In addition, lymph node stations in orange need to be dissected in D1 + dissection and lymph node stations in red as well in D2 dissection.
Fig 4
Lymph node dissection in distal gastrectomy Lymph node stations in blue need to be dissected in D1 dissection. In addition, lymph node stations in orange need to be dissected in D1 + dissection and lymph node stations in red as well in D2 dissection.
Fig 5
Lymph node dissection in pylorus-preserving gastrectomy Lymph node stations in blue need to be dissected in D1 dissection. In addition, lymph node stations in orange need to be dissected in D1+ dissection.
Fig 6
Lymph node dissection in proximal gastrectomy Lymph node stations in blue need to be dissected in D1 dissection. In addition, lymph node stations in orange need to be dissected in D1+ dissection and lymph node stations in red as well in D2 dissection.
Fig 7
Algorithm of the surgical approach and lymph node dissection for esophagogastric junctional carcinoma
Fig 8
Flowchart of DRAGON-05 study
Fig 9
Algorithm showing curability decision and additional treatments for patients who have undergone endoscopic resection
Tab 1
Incidence of nodal metastasis in various categories of early gastric cancer observed from surgically resected specimens operated at National Cancer Center Hospital and Cancer Institute Hospital[40]
| 浸润深度 | 溃疡 | 分化型 | 未分化型 | |||
|---|---|---|---|---|---|---|
| M | UL0 | 肿瘤长径 | ≤2 cm | >2 cm | ≤2 cm | >2 cm |
| 淋巴结转移发生率 | 0 (0/437) | 0 (0/493) | 0 (0/310) | 2.8% (6/214) | ||
| 95%CI | 0~0.7% | 0~0.6% | 0~0.96% | 1.0%~6.0% | ||
| UL1 | 肿瘤长径 | ≤3 cm | >3 cm | ≤2 cm | >2 cm | |
| 淋巴结转移发生率 | 0 (0/488) | 3.0% (7/230) | 3.0% (8/271) | 5.9% (44/743) | ||
| 95%CI | 0~0.6% | 0.3%~9.0% | 1.2%~5.7% | 4.3%~7.9% | ||
| SM1 | 肿瘤长径 | ≤3 cm | >3 cm | 任意长径 | ||
| 淋巴结转移发生率 | 0 (0/145) | 2.6% (2/78) | 10.6% (9/85) | |||
| 95%CI | 0~2.6% | 0.3%~9.0% | 5.0%~19.2% | |||
Fig 10
Recommended regimens for the first-, second-, third-, fourth-, or later-line treatments
Fig 11
Conditionally recommended regimens
Fig 12
Flowchart of DRAGON-07 study
Fig 13
Flowchart of DRAGON-02 study
Fig 14
Flowchart of DRAGON-03 study
Fig 15
Flowchart of DRAGON-03 study
Fig 16
Definition of PAN
Fig 17
Flowchart of DRAGON-06 study
Fig 18
Flowchart of DRAGON-08 study
Fig 19
Flowchart of DRAGON-01 study
Fig 20
Flowchart of DRAGON-09 study
Tab 2
A common clinical pathway for distal, total, and proximal gastrectomy
| 临床措施 | 临床路径的日期 |
|---|---|
| 拔除鼻胃管 | 手术当天或术后第1天 |
| 开始进食流质 | 术后第1天起 |
| 开始进食半流质 | 术后第2~4天 |
| 预防性输注抗生素 | 手术当天 |
| 拔除硬膜外导管 | 术后第3天或之前 |
| 拔除导尿管 | 术后第3天或之前 |
| 静脉补液 | 直至术后5~7天 |
| 拔除腹腔引流管 | 术后第5天或之前 |
| 出院 | 术后第8~14天 |
Tab 3
Postoperative follow-up for StageⅠ gastric cancer patient
| 术后时间 | 年 | 1 | 1.5 | 2 | 2.5 | 3 | 4 | 5 | ||
|---|---|---|---|---|---|---|---|---|---|---|
| 月 | 1 | 6 | 12 | |||||||
| 体检、PS评分、体重 | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | |
| 血液检查（肿瘤标志物等） | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | |
| CT和（或）超声检查 | ○ | ○ | ○ | ○ | ||||||
| 内镜检查 | ○ | ○ | ○ | |||||||
Tab 4
Postoperative follow-up for Stage Ⅱ-Ⅲ gastric cancer patient
| 术后时间 | 年 | 1 | 2 | 2.5 | 3 | 3.5 | 4 | 4.5 | 5 | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 月 | 1 | 3 | 6 | 9 | 12 | 15 | 18 | 21 | 24 | |||||||
| 体检、PS评分、体重 | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | |
| 血液检查（肿瘤标志物等） | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | |
| CT和（或）超声检查 | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ○ | ||||||||
| 内镜检查 | ○ | ○ | ○ | ○ | ○ | |||||||||||
Tab 5
Definition of evidence level
| 证据级别 | 定义 |
|---|---|
| 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 |
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