加强局部进展期胃癌根治手术的质量控制

Application value of multidisciplinary team model in normatively carrying out transanal total mesorectal excision

  • 摘要:  第5版日本《胃癌治疗指南》对局部进展期胃癌手术切除范围、淋巴结清扫范围做了较大修订,《中国临床肿瘤学会(CSCO)胃癌诊疗指南(2018.V1)》也就相关内容进行修订。严格按照规范要求的淋巴结清扫范围,由手术医师在离体标本按照淋巴结分组进行淋巴结分拣,病理报告中按照不同分组分别报告检出淋巴结数目及转移数目,是保障胃癌根治手术质量的关键。标准胃癌根治术后淋巴结检出数目是影响术后病理学分期准确性的决定性因素,只有分拣淋巴结数目>30枚才能满足分期、避免分期偏移。外科医师的经验、培训及手术量是决定手术质量的决定因素。胃癌治疗中心化以及医院内专业化是全面提高胃癌根治手术质量的捷径。

     

    Abstract:  The extent of gastrectomy and lymphadenectomy for locally advanced gastric cancer were revised in the 5th Japanese gastric cancer treatment guidelines. The 2018 edition of the Chinese Society of Clinical Oncology (CSCO) guidelines for the diagnosis and treatment of gastric cancer were revised according to the Japanese guidelines. The following items are extremely important for the quality control of radical gastrectomy: lymphadenectomy is carried out straitly according the guidelines, ex vivo lymph nodes are dissected from the specimen by surgeons according the different lymph node groups and the pathological report should contains the number of examined and metastatic lymph nodes of different groups individually. The number of dissected/examined lymph nodes has significant impacts on patients′ pathologic staging. In order to avoid the migration of staging, 30 and more lymph nodes should be dissected and examined. The experience of surgeons, training and operation volumes are decisive factors for the quality of operation. Centralization and specialization of gastric cancer treatment are shortcuts to improve the quality of radical gastrectomy.

     

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