多项临床研究已证实，D2淋巴结清扫是局部进展期胃癌的标准术式，标准化和规范化的淋巴结清扫是保证手术质量和提高疗效的关键。对局部进展期胃癌淋巴结清扫进行质量化控制时，建议依照第六版《日本胃癌治疗指南》的规定进行D2清扫；针对No.10、No.13、No.14v、No.16和纵隔淋巴结等D2清扫范围外的淋巴结，可依照指南和共识的建议，选择性地进行D2+淋巴结清扫，也可使部分患者获益。目前，局部进展期胃癌手术时联合大网膜切除仍是标准术式，是否保留大网膜仍需更多临床研究结果的验证。胃癌术后规范化的淋巴结送检为术后精准分期奠定基础，建议送检30枚以上的淋巴结以确保精准分期，避免分期偏倚。 Numerous studies have confirmed that D2 lymphadenectomy is the standard surgery for locally advanced gastric cancer. Standardized lymph node dissection plays a crucial role in ensuring surgical quality and efficacy. It is recommended to perform D2 lymph node dissection according to the 6th edition of the Japanese gastric cancer treatment guidelines. For lymph nodes beyond the scope of D2 lymph node dissection, such as No.10, 13, 14v, 16 and mediastinal lymph nodes, selective D2+ lymph node dissection can be performed, which may be advantageous for some patients. Currently, omentectomy is the standard surgical procedure for locally advanced gastric cancer. However, the clinical significance of gastrectomy with preservation of the greater omentum requires further validation through large-scale clinical trials. Standardized ex vivo lymph node dissection is important for accurate postoperative staging, and it is recommended to harvest more than 30 lymph nodes to avoid staging deviation.
Quality control of lymph node dissection for locally advanced gastric cancer
Numerous studies have confirmed that D2 lymphadenectomy is the standard surgery for locally advanced gastric cancer. Standardized lymph node dissection plays a crucial role in ensuring surgical quality and efficacy. It is recommended to perform D2 lymph node dissection according to the 6th edition of the Japanese gastric cancer treatment guidelines. For lymph nodes beyond the scope of D2 lymph node dissection, such as No.10, 13, 14v, 16 and mediastinal lymph nodes, selective D2+ lymph node dissection can be performed, which may be advantageous for some patients. Currently, omentectomy is the standard surgical procedure for locally advanced gastric cancer. However, the clinical significance of gastrectomy with preservation of the greater omentum requires further validation through large-scale clinical trials. Standardized ex vivo lymph node dissection is important for accurate postoperative staging, and it is recommended to harvest more than 30 lymph nodes to avoid staging deviation.
Stomach neoplasms, locally advancedRadical resectionLymph node dissectionQuality control
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