摘要腹腔镜手术具有其独特的微创优势,但考虑到进展期胃癌需要进行D2淋巴结清扫,手术难度大,操作复杂,初期腹腔镜手术仅用于治疗早期胃癌.经过十几年的发展,目前已有大样本多中心临床数据证实了腹腔镜胃癌根治术治疗早期胃癌的安全性、可行性和有效性.基于高质量循证医学证据,第4版日本《胃癌治疗指南》已经将腹腔镜手术推荐为临床Ⅰ期远端胃癌手术的常规方式.然而,由于缺乏高级别循证医学证据,腹腔镜胃癌手术治疗进展期胃癌的有效性和安全性仍存争议.目前,中国、日本和韩国的前瞻性、多中心研究正在试图阐明腹腔镜手术治疗进展期胃癌的安全性和有效性.我国CLASS-01研究的安全性分析提供了全球首个局部进展期腹腔镜胃癌手术安全性的最高级别证据:由具备丰富经验的团队施行腹腔镜远端胃癌D2根治术治疗局部进展期胃癌安全可行.2016年的美国临床肿瘤协会(ASCO)年会上,韩国KLASS-02研究的安全性报道也提示了类似的研究结果.两项研究的长期肿瘤学疗效结果尤为令人期待.回顾整个胃癌外科手术发展历程不难发现,其主流方向正在从"标准和扩大化手术切除"逐渐向"个体化和精准化手术"转变,以使手术安全性和患者术后生活质量最优化.这就是腹腔镜微创外科理念指导下的新微创外科理念 ——不仅在于手术切口的缩短,更在于肿瘤学根治基础上的组织创伤最小化和功能保留最大化.基于该理念,进一步减少创伤、功能保留的微创外科新技术 ——前哨淋巴结(SN)术中导航和相关的荧光分子成像技术逐渐在胃癌手术中得到应用.目前,其相应的腹腔镜前哨淋巴结术中导航手术的有效性和功能保留的腹腔镜胃癌手术的可行性等一系列研究正在中国、日本和韩国积极开展、或准备当中,其结果可能会进一步推动腹腔镜胃癌微创手术"质"的跨越.

abstractsLaparoscopic surgery has its unique minimally invasive advantages, however, taking the complex and difficult D2 lymph node dissection for advanced gastric cancer into consideration, laparoscopic gastrectomy was only applied in the treatment of early gastric cancer at its preliminary stage. With the development of more than a decade, many multicenter clinical data have confirmed the safety, feasibility and effectiveness of laparoscopic radical gastrectomy for early gastric cancer. Based on high-quality evidence-based medicine evidence, laparoscopic gastrectomy has been recommended as an optional treatment for stageⅠgastric cancer by the Japanese Gastric Cancer Treatment Guidelines 2014(ver.4). However, the safety and effectiveness of laparoscopic gastrectomy for advanced gastric cancer remains controversial due to the lack of high-level evidence-based clinical evidence. Currently, China, Japan and South Korea are trying to clarify its safety and effectiveness by conducting well-designed multicenter prospective randomized controlled trials. To date, CLASS-01 trial in China, whose secondary endpoint indicated that laparoscopic gastrectomy with D2 lymphadenectomy for advanced gastric cancer can be safely performed by experienced surgeons, has provided the highest level evidence for the controversy in the world. At ASCO 2016, the safety reports from Korea's KLASS-02 trial also presented the similar conclusion. The long-term oncologic outcomes of the both researches were particularly promising. Retrospecting the whole development of gastric cancer surgery, it is not difficult to find that its mainstream direction is gradually shifted from "extended and standardized surgical resection"to"individual and precise surgery"for the safety and postoperative quality of life. The new concept of minimally invasive surgery built on laparoscopic surgery emphasizes more than shortening the surgical incision, but minimizing tissue trauma and maximizing functional preservation. On the ground of this new minimally invasive concept, surgeons have appreciated to select the most rational treatment for an individual patient. Thus, techniques focusing on further assisting laparoscopic gastrectomy with reducing trauma and preserving function, such as sentinel node navigation surgery and related fluorescence molecular imaging techniques, are increasingly being applied in gastric cancer surgery. At present, a series of researches about the feasibility of sentinel node navigation surgery and function preserving surgery associated with gastric cancer surgery are actively conducted or prepared. Results of these researches may further promote the development of laparoscopic gastrectomy and achieve the qualitative change in minimally invasive surgery in the new era.