第5版日本《胃癌治疗指南》缩小了胃癌标准手术的切除范围,不推荐对近端非大弯侧胃癌行脾切除,对于cT3/4期胃癌不推荐行网膜囊切除.对于Ⅳ期病例,不推荐手术+化疗的治疗模式,化疗+手术可能是选项之一.扩大了早期胃癌行内镜黏膜下剥离术(ESD)的绝对适应证.增加了新的化疗药物、靶向药物和化疗方案,例如奥沙利铂和RAM单抗被批准用于胃癌的化疗和靶向治疗.扩大了卡培他滨和奥沙利铂用于围手术期化疗的适应证.选择了30~40个临床问题,经过讨论后给予最可能的回答.第15版日本《胃癌处理规约》与第8版国际抗癌联盟/美国癌症联合委员会(UICC/AJCC)胃癌分期系统进行了整合,该分期是基于国际胃癌学会胃癌TNM分期项目的结果修订的,第一次体现了国际化.第15版日本《胃癌处理规约》修订了幽门下组淋巴结,将其分成No.6a、No.6v和No.6i三个亚组.对腹膜转移分级进行修订,将P1按转移范围进一步分成P1a、P1b和P1c.如果胃窦癌侵犯十二指肠,No.13淋巴结发生转移,应该视为区域淋巴结转移,不做为M1对待.传统意义的R0不适用于对ESD手术质量的评估.食管胃结合部癌的诊断标准应该结合内镜所见、上消化道造影及病理诊断.对化疗疗效评价标准进行修订,确定了肿瘤消退的界值为10%.%According to the Japanese gastric cancer treatment guidelines, the 5th edition, splenectomy is not recommended to the standard D2 procedure for proximal gastric cancer that does not invade the greater curvature. Bursectormy is not recommended as a standard treatment for cT3/4 gastric cancer."Surgery first followed by chemotherapy"strategy is not recommended but chemotherapy first can be a choice for patients with stage IV gastric cancer. Absolute indication for standard EMR/ESD is expanded for early gastric cancer. Oxaliplatin and Ramucirumab are approved for chemotherapy and target therapy for gastric cancer. The indication of Capecitabine and oxaliplatin to perioperative chemotherapy is expanded. 30-40 clinical questions were selected and best possible answers after discuss are be done. Based on IGCA TNM Project, the 15th Japanese and 8th UICC/AJCC Classification are integrated and for the first time, it has international view. According to the 15th Japanese Classification of Gastric Carcinoma, No.6 lymph nodes are redefined as No.6a, No.6v and No.6i. Revision of macroscopic peritoneal metastasis (P1) has been made. According to the metastasis extent, P1 is divided into P1a, P1b and P1c. In case with duodenal invasion of gastric cancer, if No.13 lymph nodes metastasis is present, such metastasis is considered to be regional but not M1. R concept is not suitable in endoscopic resection. The definition of EGJ cancer is depended on the endoscopic findings, upper gastrointestinal series and pathological study. The criteria of pathological response rate is modified and the 10%of residual tumors cutoff is defined.
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