本胃癌腹腔镜ppt课件

1、 japanese experience 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 20050 02002004004006006008008001000100012001200140014009191 92929393949

2、4 9595 969697979898 999900000101total gastrectomyproximal gastrectomydistal gastrectomy (d2 or more)distal gastrectomy(d1+)distal gastrectomy (d1)local resectionintragastric surgerymiscellaneous02020303160016001800180020002000distal gastrectomy(d1+)0 0200200400400600600800800100010001200120014001400

3、9191 929293939494 9595 969697979898 999900000101total gastrectomyproximal gastrectomydistal gastrectomy (d2 or more)distal gastrectomy(d1+)distal gastrectomy (d1)local resectionintragastric surgerymiscellaneous02020303160016001800180020002000distal gastrectomy(d1+)is lymph node dissection for early

4、gastric cancer necessary ? 0.90.90.72.73.30.55.20.8percent incidence of regional lymph node metastasis from t1(sm) cancer (l)0.9group 1 nodesgroup 2 nodes( omc experience in 1978 2000)2.21.10.64.42.50.51.70.8percent incidence of regional lymph node metastasis from t1(sm) cancer (m)0.32.70.9group 1 n

5、odesgroup 2 nodes( omc experience in 1978 2000)is lymph node dissection for early gastric cancer necessary ? “yes, it is.” n0 n1 n2 n3t1(m)t1(sm)t2t3t4h1, p1,cy1, m1,aemr(well diff., 2.)gastrectomy with d2agastrectomy with d2bextended surgerygastrectomy +d2agastrectomy +d2bgastrectomy +d2extended su

6、rgpalliative surgchemotherapyradiation therguidelines for gastric cancer treatment (2001)： ： recommendable mode of treatment defined by disease stage ( standard care, and n0 n1 n2 n3t1(m)t1(sm)t2t3t4h1, p1,cy1, m1,aemr(well diff., 2.0.)gastrectomy with d2 ( 2.)laparosopic gastrectomygastrectomy with

7、 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)advan

8、ced cancer strategy for gc treatment mucosal canceremrlaparoscopic surgeryopen surgery(omc 2004)submucosal cancerlap gastrectomy for early cancer( 1,622 cases in 21 leading institutions)wedge resection 96 (6%)inragastric resection 35 (2%)total gastrectomy 66(4%)distal gastrectomy 1,218 (75%)pylorus

9、preserving gastrectomy 131 (8%)proximal gastrectomy 76 (5%)(lap study group funded by jp ministry of health, welfare and laborseptember, 2004)complications in japanese nationwide experience of lap-dg stomal stenosis 103/2600 (3.9) wound infection 45/ 2600 (1.7) anastomotic leakage 43/ 2600 (1.6) pan

10、creatitis 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 (%)55512位置位置lymph node dissection around lge vesselslgevlgevlymph node dissection around rge vesselsgdargealymph node dissection around rg vessels (from anterior aspect)ly

11、mph node dissection around pha phalymph node dissection around cha, lga, spa and ceachapancreaslymph node dissection around smv(14v)当科当科roux-y再建手技再建手技腹腔鏡下胃癌手術後腹壁傷腹腔鏡下胃癌手術後腹壁傷median number of retrieved lymph nodes, blood loss, and operative time in open and laparoscopic distal gastrectomy group 1 lym

12、ph 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 conclusion-ldg in generaln with recent advent of instrumentation, laparoscopic approach is increasingly applied for patients with early cancer.n prope