寺岛雅典教授

在日本，局部进展期胃癌当前主流治疗策略仍以辅助化疗为主。随着多项临床研究结果公布，日本的部分临床实践开始向围术期治疗方向转变。但临床分期是最为核心的问题。对于部分Ⅰ期、Ⅱ期患者，并不需要强化治疗；仅接受单纯手术，或是手术联合辅助治疗，就可以实现超过90%的5年生存率，这部分患者无需高强度治疗。未来我们需要进一步探讨围术期治疗的最佳适用人群，例如Ⅱ期、Ⅲ期等不同分期的患者群体。

Evidence for perioperative treatment of gastric cancer continues to evolve, while treatment strategies in Japan still differ from those in Western countries. Do you think the emerging evidence is beginning to change perioperative treatment in Japan? What key questions about neoadjuvant treatment still need to be answered before it can further change clinical practice in Japan?

Prof. Masanori Terashima：

Actually, in Japan, the current treatment strategy for locally advanced gastric cancer mainly relies on adjuvant chemotherapy. However, following several clinical trials, some clinical practice in Japan has shifted toward perioperative treatment. Nevertheless, clinical staging remains the most critical issue. For patients with pathological stage Ⅰ or stage Ⅱ disease, intensive treatment is not required. Surgery alone or surgery plus adjuvant therapy can achieve a 5-year survival rate of more than 90%. These patients do not need intensive treatment. In the future, we need to further discuss the optimal candidates for perioperative therapy, including patients with stage Ⅱ, stage Ⅲ and other disease stages.

寺岛雅典教授

近些年化疗方案不断进步，很多患者仅接受化疗或化疗联合免疫治疗，生存期就可以超过5年，无需手术干预。因此，相较于过去，转化手术的临床价值受到一定的质疑。为解答该临床疑问，日本临床肿瘤学组（JCOG）正在开展一项随机对照试验，对比持续化疗与转化手术两种治疗模式的疗效。我认为这项研究对于解答该关键临床问题至关重要，该研究也将帮助我们筛选适合接受转化手术的合适人群。

As systemic therapies such as immunotherapy improve response and survival, more patients with metastatic gastric cancer may become candidates for surgery. At the same time, it is becoming more difficult to determine how much of the long-term benefit comes from systemic therapy and how much comes from conversion surgery. How can we identify the patients who truly benefit from conversion surgery? What is the most important evidence gap in this field?

Prof. Masanori Terashima：

In recent years, advances in chemotherapy have enabled many patients to survive more than five years with chemotherapy or chemoimmunotherapy alone without surgical intervention. As a result, the role of conversion surgery has become somewhat questionable compared with previous periods. To address this clinical question, the Japan Clinical Oncology Group (JCOG) is conducting a randomized controlled trial to compare continued chemotherapy versus conversion surgery. I think this study is very important to answer this critical question, and it will help us identify appropriate candidates for conversion surgery.

肿瘤瞭望消化时讯：机器人胃癌手术已经积累了越来越多的临床经验和研究证据。现阶段，我们关注的可能已经不再只是“机器人能不能完成胃癌手术”，而是它究竟能为患者带来哪些传统腹腔镜手术难以替代的临床价值。您认为下一阶段机器人胃癌手术最需要回答的问题是什么？

寺岛雅典教授

在日本，机器人辅助胃切除术应用越来越普遍。日本政府已经将机器人手术产生的额外费用纳入医保报销。但目前我们仍缺乏高级别证据证实机器人辅助胃切除术的优越性。我们开展了MONA LISA试验（日本临床肿瘤学组代号：JCOG1907），用于评估机器人胃癌切除术与腹腔镜胃癌切除术的疗效；该研究结果将于明年在旧金山举办的ASCO-GI会议上公布。无论该研究结果为阳性还是阴性，日本接受机器人手术的患者占比仍在快速升高。外科医生普遍认为，机器人辅助手术的操作难度低于腹腔镜手术。对于高难度病例，例如肥胖患者、全胃切除手术以及食管癌病例，机器人胃切除术相较于传统腹腔镜手术可能具备巨大优势。

Robotic surgery for gastric cancer has accumulated increasing clinical experience and evidence. At this stage, the question may no longer be simply whether robotic gastrectomy can be performed, but what clinical value it can offer that conventional laparoscopic surgery cannot easily provide. What do you think is the most important question that robotic gastric cancer surgery needs to answer next?

Prof. Masanori Terashima：

Robotic gastrectomy is becoming increasingly common in Japan. The Japanese government provides reimbursement for the additional costs of robotic surgery. However, we still lack high-level evidence to prove the superiority of robot assisted gastrectomy. We have conducted the MONA LISA trial (Japanese Clinical Oncology Group code: JCOG1907) was used to evaluate the efficacy of robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer. The results will be presented at next year’s ASCO-GI meeting in San Francisco. Regardless of whether the study yields positive or negative results, the proportion of patients receiving robotic therapy is rising rapidly in Japan. Surgeons believe that robot?assisted surgery is technically easier to perform than laparoscopic surgery. For difficult cases such as obese patients, total gastrectomy and esophageal cancer, robotic gastrectomy may have substantial advantages over conventional laparoscopic gastrectomy.

· 专家介绍 ·

寺岛雅典

医学博士，FACS ：寺岛教授现任静冈癌症中心胃外科主任。该中心为日本胃癌手术量排名第三的医疗机构，目前年开展机器人手术约150台、腹腔镜手术约100台、开放手术约50台。他曾担任日本临床肿瘤研究组（JCOG）胃癌研究小组主席，作为主要研究者主导多项里程碑式临床试验。寺岛教授精通各类胃癌手术，从扩大淋巴结清扫到达芬奇机器人微创系统均能娴熟应用，个人机器人胃切除术已完成400余例。他于2019年担任第91届日本胃癌学会年会主席。此外，寺岛教授致力于转化医学研究，利用人胃癌样本开展代谢组学分析及外显子组测序等前沿探索。