Rethinking the scope of lymphadenectomy after neoadjuvant immunotherapy for locally advanced gastric cancer
10.3760/cma.j.cn441530-20240507-00168
- VernacularTitle:局部进展期胃癌新辅助免疫治疗后淋巴结清扫范围的再思考
- Author:
Lisheng CHEN
1
;
Feng XU
;
Xi YANG
;
Guihua WANG
Author Information
1. 华中科技大学同济医学院附属同济医院胃肠外科，武汉 430030
- Keywords:
Stomach neoplasms, locally advanced;
Neoadjuvant therapy;
Immunotherapy;
Immune checkpoint inhibitor;
Lymphadenectomy
- From:
Chinese Journal of Gastrointestinal Surgery
2024;27(7):672-677
- CountryChina
- Language:Chinese
-
Abstract:
Radical gastrectomy is the core of comprehensive treatment for patients with locally advanced gastric cancer,while reasonable and standardized lymphadenectomy is the key to radical gastrectomy.With the continuous development of treatment methods and therapeutic drugs for advanced gastric cancer, it is worth exploring whether the scope of lymphadenectomy needs to be changed. Neoadjuvant immunotherapy has brought a new breakthrough for locally advanced gastric cancer, increased pathological complete response rate, reduced clinical stage of tumors, and increased radical surgical resection rate, but it has not brought long-term benefits to patients. Lymph nodes play an important role in human anti-tumor immune response, and some basic studies suggest that preserving some normal lymph nodes may be more helpful to enhance the efficacy of immunotherapy. Thus, in the era of immunotherapy, the extent of lymph node dissection for locally advanced gastric cancer needs to balance continuous drug benefits, patient quality of life, and survival benefits, awaiting further high-quality clinical research for determination. Questions such as how to differentiate between normal and metastatic lymph nodes, how to rationally preserve normal lymph nodes, and whether preserving partial lymph node function can lead to greater benefits for patients from immunotherapy warrant further exploration.
