本胃癌腹腔镜课件

1、 JapaneseExperience of Laparoscopic Oncologic GastrectomyNobuhiko Tanigawa, MD, FACS and Kyoichi Takaori, MD Department of General and Gastroenterological SurgeryOsaka Medical College, Osaka, JapanAt Peking University April 6th 2005本胃癌腹腔镜 JapaneseExperience of Nobuhi020040060080010001200140091929394

2、95969798990001Total gastrectomyProximal gastrectomyDistal gastrectomy (D2 or more)Distal gastrectomy(D1+)Distal gastrectomy (D1)Local resectionIntragastric surgeryLaparoscopic Surgery for Gastric Cancer in Japan（year）（cases）(7th Nationwide Survey, 2004, JSES)Miscellaneous0203160018002000Distal gastr

3、ectomy(D1+)本胃癌腹腔镜020040060080010001200140091902004006008001000120014009192939495969798990001Total gastrectomyProximal gastrectomyDistal gastrectomy (D2 or more)Distal gastrectomy(D1+)Distal gastrectomy (D1)Local resectionIntragastric surgeryLaparoscopic Surgery for Gastric Cancer in Japan（year）（case

4、s）(7th Nationwide Survey, 2004, JSES)Miscellaneous0203160018002000Distal gastrectomy(D1+)本胃癌腹腔镜0200400600800100012001400919Is lymph node dissection for early gastric cancer necessary ? 本胃癌腹腔镜Is lymph node dissection for 本0.90.90.72.73.30.55.20.8Percent incidence of regional lymph node metastasis fro

5、m T1(sm) cancer (L)0.9Group 1 nodesGroup 2 nodes( OMC experience in 1978 2000)本胃癌腹腔镜0.90.90.72.73.30.55.20.8Percen2.21.10.64.42.50.51.70.8Percent incidence of regional lymph node metastasis from T1(sm) cancer (M)0.32.70.9Group 1 nodesGroup 2 nodes( OMC experience in 1978 2000)本胃癌腹腔镜2.21.10.64.42.50.

6、51.70.8PercenIs lymph node dissection for early gastric cancer necessary ? “Yes, it is.”本胃癌腹腔镜Is lymph node dissection for “ N0 N1 N2 N3T1(M)T1(SM)T2T3T4H1, P1,CY1, M1,AEMR(Well diff., 2.)Gastrectomy with D2AGastrectomy with D2BExtended SurgeryGastrectomy +D2AGastrectomy +D2BGastrectomy +D2Extended

7、SurgPalliative SurgChemotherapyRadiation therGuidelines for Gastric Cancer Treatment (2001)：Recommendable Mode of Treatment defined by Disease Stage ( Standard Care, and本胃癌腹腔镜 N0 N0 N1 N2 N3T1(M)T1(SM)T2T3T4H1, P1,CY1, M1,AEMR(Well diff., 2.0.)Gastrectomy with D2 ( 2.)Laparosopic gastrectomyGastrect

8、omy with D2AGastrectomy with D2BExtended SurgeryGastrectomy +D2AGastrectomy +D2BGastrectomy +D2Extended SurgPalliative SurgChemotherapyRadiation therGuidelines for Gastric Cancer Treatment (2001)：Recommendable Mode of Treatment defined by Disease Stage ( Standard Care, and Investigational Treatment)

9、本胃癌腹腔镜 N0 Advanced Cancer Strategy for GC Treatment Mucosal CancerEMRLaparoscopic SurgeryOpen Surgery(OMC 2004)Submucosal Cancer本胃癌腹腔镜Advanced Cancer Strategy for GLap Gastrectomy for Early Cancer( 1,622 cases in 21 leading institutions)Wedge Resection 96 (6%)Inragastric Resection 35 (2%)Total Gastr

10、ectomy 66(4%)Distal Gastrectomy 1,218 (75%)Pylorus Preserving Gastrectomy 131 (8%)Proximal Gastrectomy 76 (5%)(Lap Study Group funded by Jp Ministry of Health, Welfare and LaborSeptember, 2004)本胃癌腹腔镜Lap Gastrectomy for Early CancComplications in Japanese nationwide experience of lap-DG Stomal stenos

11、is 103/2600 (3.9) Wound infection 45/ 2600 (1.7) Anastomotic leakage 43/ 2600 (1.6) Pancreatitis or fistula 17/ 2600 (0.6) Bleeding 13/ 2600 (0.5) Ileus 13/ 2600 (0.5) Peritoneal abscess 8/ 2600 (0.3)No. of Patients (%)本胃癌腹腔镜Complications in Japanese nati55512位置本胃癌腹腔镜55512位置本胃癌腹腔镜Lymph node dissecti

12、on around LGE vesselsLGEVLGEV本胃癌腹腔镜Lymph node dissection around LLymph node dissection around RGE vesselsGDARGEA本胃癌腹腔镜Lymph node dissection around RLymph node dissection around RG vessels (from anterior aspect)本胃癌腹腔镜Lymph node dissection around RLymph node dissection around PHA PHA本胃癌腹腔镜Lymph node d

13、issection around PLymph node dissection around CHA, LGA, SpA and CeACHAPancreas本胃癌腹腔镜Lymph node dissection around CLymph node dissection around SMV(14v)本胃癌腹腔镜Lymph node dissection around S当科Roux-Y再建手技本胃癌腹腔镜当科Roux-Y再建手技本胃癌腹腔镜腹腔鏡下胃癌手術後腹壁傷本胃癌腹腔镜腹腔鏡下胃癌手術後腹壁傷本胃癌腹腔镜Median Number of Retrieved Lymph Nodes,

14、Blood Loss, and Operative Time in Open and Laparoscopic Distal Gastrectomy Group 1 lymph nodes 21.7 20.0 Open-DG (n=394) Lap-DG (n=68) Group 2 lymph nodes 16.9 12.5 Blood loss (ml) 225 180 Operative time (min) 202 331 /total /38.6 /32.5 本胃癌腹腔镜Median Number of Retrieved LymConclusion-LDG in general With recent advent of instrumentation, laparoscopic approach is increasingly applied for patients with early cancer. P