本世纪开始,胃癌是美国癌肿死亡的一个主要病因,近50年来美国和日本等地的胃癌发生率已有明显下降.由于大量病人的诊治,日本很快成为胃癌早期诊治的领先国家.尽管如此,胃癌的预后仍令人沮丧,美国的胃癌5年总生存率为15%～20%,在日本其生存率逐有改善,可从日本学习到很多的经验.日本Izumo的Shimane医科大学外科Abe在本刊曾发表评论文章,提出淋巴结转移仍然是判断T_1/T_2期胃癌预后的重要指标.早期胃癌或局限于粘膜或粘膜下层者不一定等于可治愈性病变,因为局限于粘膜下层的胃癌仍然有10%的淋巴结转移,其中约1/4病例可有复发.另一方面,T_2期胃癌,即肿瘤已浸润至胃壁固有肌层,可无淋巴结转移.对于这些病变,R_2淋巴结清扫术是否优于R_1淋巴结清扫术,对此仍有争论.日本文献提示常规R_2根治术是安全的,具有一定优点;而在欧美国家,广泛淋巴结清扫术伴有较多的并发症,Dent更著文表示R_1和R_2根治术的生存期无差别,上述分歧观点可归委于广泛淋巴结清扫术的更精确的分期,如在N_1和N_2淋巴结均有转移的病例,在西方国家的切除术中未能检出N_2淋巴结转移;而R_2根治术可及时检出N_2淋巴结转移,由此可以将第Ⅰ、Ⅱ期癌肿分别校正为第Ⅱ、Ⅲ期病灶.从生存期分析,R_1根治术的预后当然要比R_2根治术为差. Since the beginning of this century, gastric cancer has been a major cause of cancer deaths in the United States, and the incidence of gastric cancer in the United States and Japan has decreased significantly in the past 50 years. Due to the diagnosis and treatment of large numbers of patients, Japan soon became a leading country in the early diagnosis and treatment of gastric cancer. Thus, the prognosis of gastric cancer is still depressing. The 5-year overall survival rate of gastric cancer in the United States is 15% to 20%. The survival rate in Japan has been gradually improved and many experiences can be learned from Japan. Surgery at Shimane Medical University, Izumo, Japan Abe has published a review article in this journal, suggesting that lymph node metastasis is still an important indicator to determine the prognosis of T_1/T_2 gastric cancer. Early gastric cancer or confined to the mucosa or submucosa is not necessarily equivalent to curable disease, because gastric cancer confined to the submucosa There are still 10% of lymph node metastases, of which about 1 / 4 cases may have recurrence. On the other hand, T 2 gastric cancer, that is, the tumor has infiltrated to the muscularis propria of the stomach wall without lymph node metastasis. For these lesions, is R_2 lymph node dissection? Better than R_1 lymph node dissection, there is still controversy. Japanese literature suggests that conventional R_2 radical resection is safe and has certain advantages; while in Europe and America, extensive lymph node dissection is accompanied by For many complications, Dent stated that there is no difference in the survival time of radical resections between R_1 and R_2. The above disagreement can be attributed to a more precise stage of extensive lymphadenectomy, such as cases with metastases in both N_1 and N_2 lymph nodes. In the resection of western countries, N2 lymph node metastasis could not be detected. However, R2 radical resection can detect N2 lymph node metastasis in time. Therefore, stage I and stage II cancer can be corrected as stage II and III lesions respectively. Phase analysis, of course, the prognosis of R_1 radical resection is worse than that of R_2 radical resection.