本胃癌腹腔镜课件

Japanese

ExperienceofLaparoscopicOncologicGastrectomyNobuhikoTanigawa,MD,FACSandKyoichiTakaori,MDDepartmentofGeneralandGastroenterologicalSurgeryOsakaMedicalCollege,Osaka,JapanAtPekingUniversityApril6th20050200400600800100012001400'91'92'93'94'95'96'97'98'99'00'01TotalgastrectomyProximalgastrectomyDistalgastrectomy

(D2ormore)Distalgastrectomy

(D1+α)Distalgastrectomy

(D1)LocalresectionIntragastricsurgeryLaparoscopicSurgeryforGastricCancerinJapan（year）（cases）(7thNationwideSurvey,2004,JSES)Miscellaneous‘02’03160018002000Distalgastrectomy

(D1+β)0200400600800100012001400'91'92'93'94'95'96'97'98'99'00'01TotalgastrectomyProximalgastrectomyDistalgastrectomy

(D2ormore)Distalgastrectomy

(D1+α)Distalgastrectomy

(D1)LocalresectionIntragastricsurgeryLaparoscopicSurgeryforGastricCancerinJapan（year）（cases）(7thNationwideSurvey,2004,JSES)Miscellaneous‘02’03160018002000Distalgastrectomy

(D1+β)Islymphnodedissectionforearlygastriccancernecessary?

0.90.90.72.73.30.55.20.8PercentincidenceofregionallymphnodemetastasisfromT1(sm)cancer(L)0.9Group1nodesGroup2nodes(OMCexperiencein1978～2000)2.21.10.64.42.50.51.70.8PercentincidenceofregionallymphnodemetastasisfromT1(sm)cancer(M)0.32.70.9Group1nodesGroup2nodes(OMCexperiencein1978～2000)Islymphnodedissectionforearlygastriccancernecessary?

“Yes,itis.”

N0

N1

N2

N3T1(M)T1(SM)T2T3T4H1,P1,CY1,M1,ⅠAEMR

(Welldiff.,<2.0cm,UL(－))GastrectomywithD1+α

ⅠAGastrectomywithD1+α

(Welldiff,＜1.5cm)GastrectomywithD1+βⅠBGastrectomywithD2ⅡGastrectomywithD2ⅢAExtendedSurgery

ⅠBGastrectomywithD1+β(＜2.0.ｃｍ)GastrectomywithD2(>2.１.ｃｍ)ⅡGastrectomywithD2ⅢAGastrectomywithD2ⅢBExtendedSurgeryⅡGastrectomy+D2ⅢAGastrectomy+D2ⅢBGastrectomy+D2ⅣExtendedSurgPalliativeSurgChemotherapyRadiationtherGuidelinesforGastricCancerTreatment(2001)：

RecommendableModeofTreatmentdefinedbyDiseaseStage(StandardCare,and

N0

N1

N2

N3T1(M)T1(SM)T2T3T4H1,P1,CY1,M1,ⅠAEMR

(Welldiff.,<2.0cm,UL(－))GastrectomywithD1+αLaparosopicgastrectomy

ⅠAGastrectomywithD1+α

(Welldiff,＜1.5cm)GastrectomywithD1+βLaparosopicgastrectomyⅠBLaparosopicgastrectomyGastrectomywithD2ⅡGastrectomywithD2ⅢAExtendedSurgery

ⅠBGastrectomywithD1+β(>2.0.ｃｍ)GastrectomywithD2(>2.１.ｃｍ)LaparosopicgastrectomyⅡGastrectomywithD2ⅢAGastrectomywithD2ⅢBExtendedSurgeryⅡGastrectomy+D2ⅢAGastrectomy+D2ⅢBGastrectomy+D2ⅣExtendedSurgPalliativeSurgChemotherapyRadiationtherGuidelinesforGastricCancerTreatment(2001)：

RecommendableModeofTreatmentdefinedbyDiseaseStage(StandardCare,andInvestigationalTreatment)AdvancedCancer

StrategyforGCTreatment

MucosalCancer●EMRLaparoscopicSurgeryOpenSurgery(OMC

2004)SubmucosalCancerLapGastrectomyforEarlyCancer

(1,622casesin21leadinginstitutions)WedgeResection96(6%)InragastricResection35(2%)TotalGastrectomy66(4%)DistalGastrectomy1,218(75%)PylorusPreservingGastrectomy

131(8%)ProximalGastrectomy76(5%)(LapStudyGroupfundedbyJpMinistryofHealth,WelfareandLaborSeptember,2004)ComplicationsinJapanesenationwideexperienceoflap-DGStomalstenosis 103/2600(3.9)Woundinfection 45/2600(1.7)Anastomoticleakage 43/2600(1.6)Pancreatitisorfistula 17/2600(0.6)Bleeding 13/2600(0.5)Ileus 13/2600(0.5)Peritonealabscess8/2600(0.3)No.ofPatients(%)55512ポート位置LymphnodedissectionaroundLGEvesselsLGEVLGEVLymphnodedissectionaroundRGEvesselsGDARGEALymphnodedissectionaroundRGvessels

(fromanterioraspect)LymphnodedissectionaroundPHAPHALymphnodedissectionaroundCHA,LGA,SpAandCeACHAPancreasLymphnodedissectionaroundSMV(14v)当科のRoux-Y再建手技腹腔鏡下胃癌手術後の腹壁の傷MedianNumberofRetrievedLymphNodes,BloodLoss,andOperativeTimeinOpenandLaparoscopicDistalGastrectomyGroup1lymphnodes21.720.0

Open-DG(n=394)Lap-DG(n=68)Group2lymphnodes16.912.5Bloodloss(ml)225180Operativetime(min)202331

/total/38.6/32.5

Conclusion-LDGingeneralWithrecentadventofinstrumentation,laparoscopicapproachisincreasinglyappliedforpatientswithearlycancer.

Properextentoflymphnodedissectionforearlycancerappearsfeasiblewithkeepinglowerincidenceofmorbidity.However,oncologicadequacyoflymphnodedissectionisnotprovedatpresent