本胃癌腹腔镜 .ppt

JapaneseExperienceofLaparoscopicOncologicGastrectomy,NobuhikoTanigawa,MD,FACSandKyoichiTakaori,MD,DepartmentofGeneralandGastroenterologicalSurgeryOsakaMedicalCollege,Osaka,Japan,AtPekingUniversityApril6th2019,0,200,400,600,800,1000,1200,1400,91,92,93,94,95,96,97,98,99,00,01,Totalgastrectomy,Proximalgastrectomy,Distalgastrectomy(D2ormore),Distalgastrectomy(D1+),Distalgastrectomy(D1),Localresection,Intragastricsurgery,LaparoscopicSurgeryforGastricCancerinJapan,（year）,（cases）,(7thNationwideSurvey,2019,JSES),Miscellaneous,02,03,1600,1800,2000,Distalgastrectomy(D1+),0,200,400,600,800,1000,1200,1400,91,92,93,94,95,96,97,98,99,00,01,Totalgastrectomy,Proximalgastrectomy,Distalgastrectomy(D2ormore),Distalgastrectomy(D1+),Distalgastrectomy(D1),Localresection,Intragastricsurgery,LaparoscopicSurgeryforGastricCancerinJapan,（year）,（cases）,(7thNationwideSurvey,2019,JSES),Miscellaneous,02,03,1600,1800,2000,Distalgastrectomy(D1+),Islymphnodedissectionforearlygastriccancernecessary?,0.9,0.9,0.7,2.7,3.3,0.5,5.2,0.8,PercentincidenceofregionallymphnodemetastasisfromT1(sm)cancer(L),0.9,Group1nodes,Group2nodes,(OMCexperiencein19782000),2.2,1.1,0.6,4.4,2.5,0.5,1.7,0.8,PercentincidenceofregionallymphnodemetastasisfromT1(sm)cancer(M),0.3,2.7,0.9,Group1nodes,Group2nodes,(OMCexperiencein19782000),Islymphnodedissectionforearlygastriccancernecessary?,“Yes,itis.”,N0N1N2N3,T1(M)T1(SM)T2T3T4H1,P1,CY1,M1,AEMR(Welldiff.,2.)GastrectomywithD2AGastrectomywithD2BExtendedSurgery,Gastrectomy+D2AGastrectomy+D2BGastrectomy+D2,ExtendedSurgPalliativeSurgChemotherapyRadiationther,GuidelinesforGastricCancerTreatment(2019)：RecommendableModeofTreatmentdefinedbyDiseaseStage(StandardCare,and,N0N1N2N3,T1(M)T1(SM)T2T3T4H1,P1,CY1,M1,AEMR(Welldiff.,2.0.)GastrectomywithD2(2.)LaparosopicgastrectomyGastrectomywithD2AGastrectomywithD2BExtendedSurgery,Gastrectomy+D2AGastrectomy+D2BGastrectomy+D2,ExtendedSurgPalliativeSurgChemotherapyRadiationther,GuidelinesforGastricCancerTreatment(2019)：RecommendableModeofTreatmentdefinedbyDiseaseStage(StandardCare,andInvestigationalTreatment),AdvancedCancer,StrategyforGCTreatment,MucosalCancer,EMR,LaparoscopicSurgery,OpenSurgery,(OMC2019),SubmucosalCancer,LapGastrectomyforEarlyCancer(1,622casesin21leadinginstitutions),WedgeResection96(6%),InragastricResection35(2%),TotalGastrectomy66(4%),DistalGastrectomy1,218(75%),PylorusPreservingGastrectomy131(8%),ProximalGastrectomy76(5%),(LapStudyGroupfundedbyJpMinistryofHealth,WelfareandLaborSeptember,2019),ComplicationsinJapanesenationwideexperienceoflap-DG,Stomalstenosis103/2600(3.9)Woundinfection45/2600(1.7)Anastomoticleakage43/2600(1.6)Pancreatitisorfistula17/2600(0.6)Bleeding13/2600(0.5)Ileus13/2600(0.5)Peritonealabscess8/2600(0.3),No.ofPatients(%),5,5,5,12,位置,LymphnodedissectionaroundLGEvessels,LGEV,LGEV,LymphnodedissectionaroundRGEvessels,GDA,RGEA,LymphnodedissectionaroundRGvessels(fromanterioraspect),LymphnodedissectionaroundPHA,PHA,LymphnodedissectionaroundCHA,LGA,SpAandCeA,CHA,Pancreas,LymphnodedissectionaroundSMV(14v),当科Roux-Y再建手技,腹腔鏡下胃癌手術後腹壁傷,MedianNumberofRetrievedLymphNodes,BloodLoss,andOperativeTimeinOpenandLaparoscopicDistalGastrectomy,Group1lymphnodes21.720.0,Open-DG(n=394)Lap-DG(n=68),Group2lymphnodes16.912.5,Bloodloss(ml)225180,Operativetime(min)202331,/total/38.6/32.5,Conclusion-LDGingeneral,Withrecentadventofinstrumentation,laparoscopicapproachisincreasinglyappliedforpatientswithea