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在第16届国际胃癌大会（IGCC）于阿姆斯特丹圆满落幕之际，《肿瘤瞭望消化时讯》记者深入大会现场，对大会主席Dr.Henk Hartgrink进行了专访。Dr.Henk Hartgrink在访谈中，直面全球胃癌诊疗领域的挑战与困境，分享了荷兰在胃癌研究中的独特经验，更以专业视角剖析了手术技术与药物治疗的发展方向。这场对话不仅展现了国际前沿的学术思考，更为全球胃癌诊疗协作与未来突破提供了重要启示，邀您一同探寻胃癌诊疗的前行之路。

肿瘤瞭望消化时讯：作为第16届IGCC大会主席，您认为本届会议最希望传递的关键信息是什么？对于全球胃癌诊疗协作有何期待？ 

Dr.Henk Hartgrink：在这样的大会上总会有令人深思的发现，我认为大会的核心价值在于汇聚各方力量——所有致力于胃癌研究、努力验证科研成果的同仁们。说来奇怪，尽管我们投入了大量研究，但过去三十年来的治疗成果改善却微乎其微。以荷兰人口为例，胃癌患者的五年总生存率仅从20%提升至22%。这个现实确实有些令人沮丧。尽管如此，每位与会者都满怀热情，致力于推动领域发展，为胃癌患者带来更多希望。我认为本届大会提供的平台至关重要，它让我们能够充分探讨研究进展、交流学术观点，共同探索改善患者预后的有效途径。

Dr.Henk Hartgrink：Well, it's always interesting in such a congress. Then, and I think the main thing of the congress is that everybody comes together. These are all people that are interested in gastric cancer and doing research in it and try to prove results. 

Strange enough, results haven't improved much over the last 30 years. If you look for the Dutch population, the overall survival in five years has gone from 20% to 22%, despite all the research we do. So that's a bit depriming. 

Nevertheless, everybody is enthusiasting and willing to get it forward and to give a better perspective to the patients with gastric cancer. And I think the podium that this congress gives is an excellent place to discuss research and ideas and to see whether we can improve our outcomes.

肿瘤瞭望消化时讯：荷兰在胃癌临床研究领域有哪些特色？本次大会选址阿姆斯特丹是否反映了某些区域性研究进展或合作机遇？

Dr.Henk Hartgrink：荷兰很早就确立了在上消化道外科领域的研究优势，尤其胃癌诊疗已实现全国集中化管理。目前全国仅有少数几个中心开展此类手术，各团队之间彼此熟识。我们的协作模式是：当任一中心提出有价值的临床试验方案时，会联合所有中心共同参与，从而快速完成患者招募。诚然，荷兰并非胃癌高发国家（发病率远低于部分亚洲国家），但通过这种跨中心协同机制，我们成功实施了多项高质量研究，例如具有里程碑意义的D1/D2淋巴结清扫术对比试验、系列腹腔镜手术试验，以及多中心的CRITICS试验等。这种协作体系使荷兰成为开展胃癌研究的理想平台，各中心既能发挥专业优势，又可通过资源共享加速科研进程，最终为临床问题找到答案。

Dr.Henk Hartgrink：I think the Netherlands is since long a country where we do a lot of research, and what we do is actually the upper GI surgery and gastric is centralized. So there's only several centers performing these sort of operations, and everybody knows each other. And what we try to do is that if somebody has a good idea for a trial, that we try to involve all centers so that together, we have a quick accrual. 

Of course, the Netherlands is not a country which has a high incidence of gastric cancer like some Asian countries. But by doing this together and to collaborate, we can set up good trials. And so we have done in the past, we have to D1/D2 trial, some laparoscopic trials, the critics trials with many trials. 

And for that, the Dutch environment is a good place to do research and to collaborate with each other and get answers for questions.

肿瘤瞭望消化时讯：您长期致力于胃癌手术优化与综合治疗，能否分享一项近年来让您印象深刻的临床研究突破？

Dr.Henk Hartgrink：Marcus Nielsen的精彩演讲，通过研究展示了一个重要现象：某些方面的改进确实取得了进展，但并非所有改变都能带来实质性提升。有时我们自以为优化了流程，实际效果却未达预期，甚至可能适得其反——这时保持原有方案反而更稳妥。以腹腔镜手术研究为例，早期针对早期胃癌的研究显示其优势，但后续扩展至进展期肿瘤的研究却表明，与传统开放手术相比，腹腔镜手术在疗效上并无显著差异。这些非劣效性试验证实，只要操作规范，两种术式效果相当。

不过在我看来，当前腹腔镜手术的热潮更多源于技术追捧而非实际需求。研究数据显示，腹腔镜手术失血量确实更少（约减少50毫升），但这种差异在临床实践中并无实际意义。相反，手术时间的延长导致总体医疗成本上升。当然，从长期预后来看，微创手术可能带来潜在获益，这需要更多随访数据验证。

我想强调的核心观点是：技术改进需理性看待，并非所有创新都能转化为患者获益。外科医生应立足现有成熟技术，在确保疗效的前提下逐步探索优化。而真正能显著改善胃癌患者预后的突破，很可能来自药物治疗领域的革新——无论是化疗方案的优化、免疫治疗的发展，还是靶向药物的突破，这些系统性治疗手段才是提升总生存率的关键。单纯依赖手术技术的改良，难以实现根本性的治疗飞跃。

Dr.Henk Hartgrink：I think we just had a nice talk by Marcus Nielsen and what he did actually. He showed that it was improved in certain ways, but not every change is in improvements. 

So for some things, we think things are better, but they are not and they better stay at the old place. So I think some improvement in this way. But for instance, there's many studies on that proscopic surgery. And all these studies started with early gesture cancer and later going on to more advanced disease shows that actually there's no difference at all. There's all non inferiority trials and they show that it can be done properly. 

Everybody wants to do laposcopic toys for boys, in my opinion. And all these studies show that there is less blood loss, which is about 50 MLS or so. It's not clinically relevant and that the procedure takes longer and is therefore more expensive. On the other end, the long term effects on a leopard to me might be in the benefit of the laparoscopic performance. So it's in between.

But what I wanted to say is that for some things, there is an improvement, but not every change is an improvement. So sometimes you should stick to what you have and be happy with the techniques you have. But certainly just being, well, improvements will follow. 

And I think the main improvements, if we talked for survival or things like that, we'll have to come from a medication, from chemotherapy or immunotherapy or targeted therapies that will finally improve the overall survival. And I don't think that surgical techniques will make a lot of difference.

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