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ExperienceofLaparoscopicOncologicGastrectomyNobuhikoTanigawa,MD,FACSandKyoichiTakaori,MDDepartmentofGeneralandGastroenterologicalSurgeryOsakaMedicalCollege,Osaka,JapanAtPekingUniversityApril6th2005JapaneseExperienceofNobuhi0200400600800100012001400'91'92'93'94'95'96'97'98'99'00'01TotalgastrectomyProximalgastrectomyDistalgastrectomy
(D2ormore)Distalgastrectomy
(D1+α)Distalgastrectomy
(D1)LocalresectionIntragastricsurgeryLaparoscopicSurgeryforGastricCancerinJapan（year）（cases）(7thNationwideSurvey,2004,JSES)Miscellaneous‘02’03160018002000Distalgastrectomy
(D1+β)0200400600800100012001400'91'90200400600800100012001400'91'92'93'94'95'96'97'98'99'00'01TotalgastrectomyProximalgastrectomyDistalgastrectomy
(D2ormore)Distalgastrectomy
(D1+α)Distalgastrectomy
(D1)LocalresectionIntragastricsurgeryLaparoscopicSurgeryforGastricCancerinJapan（year）（cases）(7thNationwideSurvey,2004,JSES)Miscellaneous‘02’03160018002000Distalgastrectomy
(D1+β)0200400600800100012001400'91'9Islymphnodedissectionforearlygastriccancernecessary?
Islymphnodedissectionfor0.90.90.72.73.30.55.20.8PercentincidenceofregionallymphnodemetastasisfromT1(sm)cancer(L)0.9Group1nodesGroup2nodes(OMCexperiencein1978～2000)0.90.90.72.73.30.55.20.8Percen2.21.10.64.42.50.51.70.8PercentincidenceofregionallymphnodemetastasisfromT1(sm)cancer(M)0.32.70.9Group1nodesGroup2nodes(OMCexperiencein1978～2000)2.21.10.64.42.50.51.70.8PercenIslymphnodedissectionforearlygastriccancernecessary?
“Yes,itis.”Islymphnodedissectionfor“
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,andN0
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)N0AdvancedCancer
StrategyforGCTreatment
MucosalCancer●EMRLaparoscopicSurgeryOpenSurgery(OMC
2004)SubmucosalCancerAdvancedCancerStrategyforGLapGastrectomyforEarlyCancer
(1,622casesin21leadinginstitutions)WedgeResection96(6%)InragastricResection35(2%)TotalGastrectomy66(4%)DistalGastrectomy1,218(75%)PylorusPreservingGastrectomy
131(8%)ProximalGastrectomy76(5%)(LapStudyGroupfundedbyJpMinistryofHealth,WelfareandLaborSeptember,2004)LapGastrectomyforEarlyCancComplicationsinJapanesenationwideexperienceoflap-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(%)ComplicationsinJapanesenati55512ポート位置55512ポート位置LymphnodedissectionaroundLGEvesselsLGEVLGEVLymphnodedissectionaroundLLymphnodedissectionaroundRGEvesselsGDARGEALymphnodedissectionaroundRLymphnodedissectionaroundRGvessels
(fromanterioraspect)LymphnodedissectionaroundRLymphnodedissectionaroundPHAPHALymphnodedissectionaroundPLymphnodedissectionaroundCHA,LGA,SpAandCeACHAPancreasLymphnodedissectionaroundCLymphnodedissectionaroundSMV(14v)LymphnodedissectionaroundS當(dāng)科のRoux-Y再建手技當(dāng)科のRoux-Y再建手技腹腔鏡下胃癌手術(shù)後の腹壁の傷腹腔鏡下胃癌手術(shù)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
MedianNumberofRetrievedLymConclusion-LDGingeneralWithrecentadventofinstrumentation,laparoscopicapproachisincreasinglyappliedforpatientswithearlycancer.
Properextentoflymphnodedissectionforearlycancerappearsfeasiblewithkeepinglowerincidenceofmorbidity.However,oncologicadequacyoflymphnodedissectionisnotprovedatpresent.Conclusion-LDGingeneralWi后面內(nèi)容直接刪除就行資料可以編輯修改使用資料可以編輯修改使用后面內(nèi)容直接刪除就行主要經(jīng)營：網(wǎng)絡(luò)軟件設(shè)計、圖文設(shè)計制作、發(fā)布廣告等公司秉著以優(yōu)質(zhì)的服務(wù)對待每一位客戶，做到讓客戶滿意！主要經(jīng)營：網(wǎng)絡(luò)軟件設(shè)計、圖文設(shè)計制作、發(fā)布廣告等致力于數(shù)據(jù)挖掘，合同簡歷、論文寫作、PPT設(shè)計、計劃書、策劃案、學(xué)習(xí)課件、各類模板等方方面面，打造全網(wǎng)一站式需求致力于數(shù)據(jù)挖掘，合同簡歷、論文寫作、PPT設(shè)計、計劃書、策劃感謝您的觀看和下載Theusercandemonstrateonaprojectororcomputer,orprintthepresentationandmakeitintoafilmtobeusedinawiderfield感謝您的觀看和下載Theusercandemonstr
Japanese
ExperienceofLaparoscopicOncologicGastrectomyNobuhikoTanigawa,MD,FACSandKyoichiTakaori,MDDepartmentofGeneralandGastroenterologicalSurgeryOsakaMedicalCollege,Osaka,JapanAtPekingUniversityApril6th2005JapaneseExperienceofNobuhi0200400600800100012001400'91'92'93'94'95'96'97'98'99'00'01TotalgastrectomyProximalgastrectomyDistalgastrectomy
(D2ormore)Distalgastrectomy
(D1+α)Distalgastrectomy
(D1)LocalresectionIntragastricsurgeryLaparoscopicSurgeryforGastricCancerinJapan（year）（cases）(7thNationwideSurvey,2004,JSES)Miscellaneous‘02’03160018002000Distalgastrectomy
(D1+β)0200400600800100012001400'91'90200400600800100012001400'91'92'93'94'95'96'97'98'99'00'01TotalgastrectomyProximalgastrectomyDistalgastrectomy
(D2ormore)Distalgastrectomy
(D1+α)Distalgastrectomy
(D1)LocalresectionIntragastricsurgeryLaparoscopicSurgeryforGastricCancerinJapan（year）（cases）(7thNationwideSurvey,2004,JSES)Miscellaneous‘02’03160018002000Distalgastrectomy
(D1+β)0200400600800100012001400'91'9Islymphnodedissectionforearlygastriccancernecessary?
Islymphnodedissectionfor0.90.90.72.73.30.55.20.8PercentincidenceofregionallymphnodemetastasisfromT1(sm)cancer(L)0.9Group1nodesGroup2nodes(OMCexperiencein1978～2000)0.90.90.72.73.30.55.20.8Percen2.21.10.64.42.50.51.70.8PercentincidenceofregionallymphnodemetastasisfromT1(sm)cancer(M)0.32.70.9Group1nodesGroup2nodes(OMCexperiencein1978～2000)2.21.10.64.42.50.51.70.8PercenIslymphnodedissectionforearlygastriccancernecessary?
“Yes,itis.”Islymphnodedissectionfor“
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,andN0
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)N0AdvancedCancer
StrategyforGCTreatment
MucosalCancer●EMRLaparoscopicSurgeryOpenSurgery(OMC
2004)SubmucosalCancerAdvancedCancerStrategyforGLapGastrectomyforEarlyCancer
(1,622casesin21leadinginstitutions)WedgeResection96(6%)InragastricResection35(2%)TotalGastrectomy66(4%)DistalGastrectomy1,218(75%)PylorusPreservingGastrectomy
131(8%)ProximalGastrectomy76(5%)(LapStudyGroupfundedbyJpMinistryofHealth,WelfareandLaborSeptember,2004)LapGastrectomyforEarlyCancComplicationsinJapanesenationwideexperienceoflap-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(%)ComplicationsinJapanesenati55512ポート位置55512ポート位置LymphnodedissectionaroundLGEvesselsLGEVLGEVLymphnodedissectionaroundLLymphnodedissectionaroundRGEvesselsGDARGEALymphnodedissectionaroundRLymphnodedissectionaroundRGvessels
(fromanterioraspect)LymphnodedissectionaroundRLymphnodedissectionaroundPHAPHALymphnodedissectionaroundPLymphnodedissectionaroundCHA,LGA,SpAandCeACHAPancreasLymphnodedissectionaroundCLymphnodedissectionaroundSMV(14v)LymphnodedissectionaroundS當(dāng)科のRoux-Y再建手技當(dāng)科のRoux-Y再建手技腹腔鏡下胃癌手術(shù)後の腹壁
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