胃间质小肿瘤的微创入路:愈少愈多。

IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY
Lapo Bencini, Elvira Adinolfi
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引用次数: 0

摘要

本文对Gu等人于2024年发表的文章进行评论,探讨内镜下与腹腔镜下胃间质瘤切除术的临床/围手术期结局是否存在差异。与大多数肿瘤相比,胃肠道间质瘤在世界范围内相当常见,预后较好。然而,他们对特定的化疗有反应,不需要常规的标准淋巴结切除术。已知胃的起源是最具代表性的。经证实的根治性手术后生存率极好,复发极为罕见。目前,对于大于5cm的高危肿瘤,诱导/围手术期化疗可以降低肿瘤的发展阶段,维持良好的生存。因此,治疗非转移性、可切除肿瘤的标准是手术切除(避免正式的淋巴结切除术),伴或不伴化疗。对于小(2厘米)到中(5厘米)大小的肿瘤,微创手术方法(腹腔镜或机器人)一直被提倡,最近,一种纯内窥镜技术也被提出。所有这些干预措施都是可行和有效的,尽管没有发表明确的结果来证明一种优于另一种;然而,其相关的肿瘤学结果仍需进一步研究。不幸的是,严格的、前瞻性的、随机对照试验在进行、开发和获得伦理批准方面具有挑战性,而手术路线的最终决定通常与仪器的可用性和当地专家有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Minimally invasive approaches to small gastric stromal tumors: The less with the more.

In this paper, we comment on the article by Gu et al published in 2024, investigating whether there were differences in the clinical/perioperative outcomes of endoscopic and laparoscopic resections of gastric stromal tumors. Compared with most carcinomas, gastrointestinal stromal tumors are quite common worldwide and have a better prognosis. However, they respond to specific chemotherapies and do not routinely require standard lymphadenectomy. The gastric origin is known to be the most represented. Survival after proven radical surgery is excellent, with recurrences being extremely infrequent. Currently, induction/perioperative chemotherapy for high-risk tumors larger than 5 cm can downstage neoplasia and maintain good survival. Therefore, the standard of care for nonmetastatic, resectable tumors is surgical excision (avoiding formal lymphadenectomy) with or without chemotherapy. In the case of small- (2 cm) to medium- (5 cm) sized tumors, minimally invasive surgical approaches (laparoscopic or robotic) have been advocated, and more recently, a purely endoscopic technique has also been proposed. All these interventions are feasible and effective, although no definitive results have been published to prove the superiority of one over another; however, further investigation of its associated oncologic outcomes is still needed. Unfortunately, rigorous, prospective, randomized controlled trials are challenging to conduct, develop, and receive ethical approval for, whereas the final decision of the surgical route is often related to the availability of instrumentation and local expertise.

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