Basic concept of gastric cancer treatment when we consider the social backgroud of the aging society is undoubtedly ’’ minimally invasive and tailored approaches”.

 

Since Theodor Billroath performed the first gastrectomy in 1881， a number of improvements and developments have been made in the surgical management of gastric cancer. Today， we are utilizing not only surgical procedure but also multidisciplinary approaches. In the 20th century， we saw the establishment of standard procedures of resection， lymph node dissection and reconstruction in gastric cancer surgery. Now， in 21st century， I believe the key word for further improving the management GI cancer　is ’’ individualization’’. Because of well-established health check-up system and widespread application of video-endoscopy in Japan， many asymptomatic cases of early gastric cancer (EGC) are detected. Endoscopic submucosal dissection (ESD) is already accepted as most minimally invasive procedure for the resection of EGC. We have examined a method using an oblique view double channel therapeutic video-endoscope for larger mucosal cancer (ESD). Laparoscopic surgery is an important intermediate option between ESD and open surgery for patients with EGC. Now， we have many skilled laparoscopic surgeons demonstrating the technical feasibility of a complete laparoscopic gastrectomy or D2 lymphoadenectomy even in advanced gastric cancer. Currently the diagnostic sensitivity of preoperative imagings to detect micrometastasis in regional lymph nodes has developed to perform precisely the minimally invasive and tailored approaches for gastric cancer ( Concept of Sentinel Node Navigation Surgery). Fluorescence image guided surgery is a candidate for supporting intraoperative recognition of lymphatic flow， lymphatic metastasis and organ blood flow.

 

Laparoscopic surgery is a relatively difficult procedure for surgeons because of the limitations of maneuverability and tactile sensation. To prove these problems， we need to develop the harmonization between medicine and technology.

 

Advanced engineering technology， especially robotics， has already been in laparoscopic surgery. We have developed a combined master-slave manupulator with tactile sensation. On the other hand， future advanced medical devices are promoting supported by Japan Agency for Medical Research and Development as national policy.

 

Finally the important concept of treatment for gastric cancer is multidisciplinary approach including chemotherapy and herbal medicine ( Kampo ).

 

 

正崎吉岛
国际   生福利大学

 

考虑当前人口老龄化的社会背景，目前胃癌治疗的基本概念无疑是“微创和精准医疗”。

 

自从1881年Theodor Billroath第一次完成了胃癌切除术以来，胃癌在手术治疗方面取得了一系列的进展。现在我们不仅可以应用外科手术治疗胃癌，还创立了多学科治疗方法。 

 

20世纪，我们建立了胃癌根治术的手术切除、淋巴结清扫和重建的标准手术流程。到了二十一世纪，我认为进一步改善胃肠道肿瘤治疗的关键词是“个体化”。随着健康检查体系的健立和完善，视频内窥镜在日本得到了广泛应用，许多无症状的早期胃癌（EGC）病例都可以被检测到。内窥镜粘膜下剥离术（ESD）也已经被认为是切除EGC的最微创手术。我们还进一步研究了斜视双通道治疗视频内窥镜作为较大粘膜癌（ESD）切除的方法。腹腔镜手术是EGC患者介于ESD和开放手术之间的一个重要选择。目前日本许多技术精湛的腹腔镜外科医生都表示，即使在晚期胃癌中，完全腹腔镜胃癌切除术或D2淋巴结切除术在技术方面都具有可行性。另外，术前诊断区域淋巴结微转移的影像学检查手段的敏感性也得到了进一步提升，以实现胃癌的精准微创以及个体化治疗（哨淋巴结导航手术概念）。荧光图像引导手术还能够术中识别淋巴液、淋巴结转移以及器官的血流。

 

由于手术和触觉的限制，腹腔镜手术对于外科医生来说是相对困难的手术。为了更好地解决这些问题，我们需要医学和科技的协调发展。

 

先进的工程学技术，特别是机器人技术已经广泛用于腹腔镜手术中，我们还开发了一种具有触感的组合主从控制器。另一方面，未来先进医疗器械在日本医学研究与发展机构的支持下，已经逐步上升到国家政策的高度。

 

最后，胃癌另一个重要的治疗理念是包括化疗和中医治疗在内的多学科治疗。