本胃癌腹腔镜课件.ppt

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1、JapaneseExperience of Laparoscopic Oncologic Gastrectomy,Nobuhiko Tanigawa, MD, FACS and Kyoichi Takaori, MD,Department of General and Gastroenterological SurgeryOsaka Medical College, Osaka, Japan,At Peking University April 6th 2005,本胃癌腹腔镜,JapaneseExperience of Nobuhi,0,200,400,600,800,1000,1200,14

2、00,91,92,93,94,95,96,97,98,99,00,01,Total gastrectomy,Proximal gastrectomy,Distal gastrectomy (D2 or more),Distal gastrectomy(D1+),Distal gastrectomy (D1),Local resection,Intragastric surgery,Laparoscopic Surgery for Gastric Cancer in Japan,（year）,（cases）,(7th Nationwide Survey, 2004, JSES),Miscella

3、neous,02,03,1600,1800,2000,Distal gastrectomy(D1+),本胃癌腹腔镜,0200400600800100012001400919,0,200,400,600,800,1000,1200,1400,91,92,93,94,95,96,97,98,99,00,01,Total gastrectomy,Proximal gastrectomy,Distal gastrectomy (D2 or more),Distal gastrectomy(D1+),Distal gastrectomy (D1),Local resection,Intragastric

4、 surgery,Laparoscopic Surgery for Gastric Cancer in Japan,（year）,（cases）,(7th Nationwide Survey, 2004, JSES),Miscellaneous,02,03,1600,1800,2000,Distal gastrectomy(D1+),本胃癌腹腔镜,0200400600800100012001400919,Is lymph node dissection for early gastric cancer necessary ?,本胃癌腹腔镜,Is lymph node dissection fo

5、r 本,0.9,0.9,0.7,2.7,3.3,0.5,5.2,0.8,Percent incidence of regional lymph node metastasis from T1(sm) cancer (L),0.9,Group 1 nodes,Group 2 nodes,( OMC experience in 1978 2000),本胃癌腹腔镜,0.90.90.72.73.30.55.20.8Percen,2.2,1.1,0.6,4.4,2.5,0.5,1.7,0.8,Percent incidence of regional lymph node metastasis from

6、 T1(sm) cancer (M),0.3,2.7,0.9,Group 1 nodes,Group 2 nodes,( OMC experience in 1978 2000),本胃癌腹腔镜,2.21.10.64.42.50.51.70.8Percen,Is 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 N3,T1(M)T1(SM)T2T3T4H1, P1,CY1, M1,AEMR(Well diff

7、., 2.0cm,UL () )Gastrectomy with D1+ AGastrectomy with D1+ (Well diff, 1.5cm)Gastrectomy with D1+ BGastrectomy with D2Gastrectomy with D2 AExtended Surgery,BGastrectomy with D1+ (2.0.)Gastrectomy with D2 ( 2.)Gastrectomy with D2AGastrectomy with D2BExtended Surgery,Gastrectomy +D2AGastrectomy +D2BGa

8、strectomy +D2,Extended SurgPalliative SurgChemotherapyRadiation ther,Guidelines 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 N3,T1(M)T1(SM)T2T3T4H1, P1,CY1, M1,AEMR(Well diff., 2.0cm,UL () )Gastrectomy with D1+La

9、parosopic gastrectomy AGastrectomy with D1+ (Well diff, 1.5cm)Gastrectomy with D1+ Laparosopic gastrectomyBLaparosopic gastrectomyGastrectomy with D2Gastrectomy with D2 AExtended Surgery,BGastrectomy with D1+ (2.0.)Gastrectomy with D2 ( 2.)Laparosopic gastrectomyGastrectomy with D2AGastrectomy with

10、D2BExtended Surgery,Gastrectomy +D2AGastrectomy +D2BGastrectomy +D2,Extended SurgPalliative SurgChemotherapyRadiation ther,Guidelines for Gastric Cancer Treatment (2001)：Recommendable Mode of Treatment defined by Disease Stage ( Standard Care, and Investigational Treatment),本胃癌腹腔镜,N0,Advanced Cancer

11、,Strategy for GC Treatment,Mucosal Cancer,EMR,Laparoscopic Surgery,Open Surgery,(OMC 2004),Submucosal Cancer,本胃癌腹腔镜,Advanced Cancer Strategy for G,Lap Gastrectomy for Early Cancer( 1,622 cases in 21 leading institutions),Wedge Resection 96 (6%),Inragastric Resection 35 (2%),Total Gastrectomy 66(4%),

12、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 Canc,Complications in Japanese nationwide experience of lap-DG,Stomal stenosis 103/

13、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 nati,5,5,5,12,位置,本胃癌腹腔镜,55512位置本胃癌腹腔镜,Lymph node diss

14、ection around LGE vessels,LGEV,LGEV,本胃癌腹腔镜,Lymph node dissection around L,Lymph node dissection around RGE vessels,GDA,RGEA,本胃癌腹腔镜,Lymph node dissection around R,Lymph node dissection around RG vessels (from anterior aspect),本胃癌腹腔镜,Lymph node dissection around R,Lymph node dissection around PHA,PHA,

15、本胃癌腹腔镜,Lymph node dissection around P,Lymph node dissection around CHA, LGA, SpA and CeA,CHA,Pancreas,本胃癌腹腔镜,Lymph node dissection around C,Lymph 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

16、 Number of Retrieved Lymph Nodes, 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 Retri

17、eved Lym,Conclusion-LDG in general,With recent advent of instrumentation, laparoscopic approach is increasingly applied for patients with early cancer. Proper extent of lymph node dissection for early cancer appears feasible with keeping lower incidence of morbidity. However, oncologic adequacy of lymph node dissection is not proved at present.,本胃癌腹腔镜,Conclusion-LDG in general Wi,