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 2005本胃癌腹腔镜0 02002004004006006008008001000100012001200140014009191 9292939394
2、94 9595 969697979898 999900000101Total gastrectomyProximal gastrectomyDistal gastrectomy(D2 or more)Distal gastrectomy(D1+)Distal gastrectomy(D1)Local resectionIntragastric surgeryMiscellaneous02020303160016001800180020002000Distal gastrectomy(D1+)本胃癌腹腔镜0 02002004004006006008008001000100012001200140
3、014009191 929293939494 9595 969697979898 999900000101Total gastrectomyProximal gastrectomyDistal gastrectomy(D2 or more)Distal gastrectomy(D1+)Distal gastrectomy(D1)Local resectionIntragastric surgeryMiscellaneous02020303160016001800180020002000Distal gastrectomy(D1+)本胃癌腹腔镜Is lymph node dissection f
4、or early gastric cancer necessary?本胃癌腹腔镜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)本胃癌腹腔镜2.21.10.64.42.50.51.70.8Percent incidence of regional lymph node metastasis from T1(sm)cancer(M)0.32
5、.70.9Group 1 nodesGroup 2 nodes(OMC experience in 1978 2000)本胃癌腹腔镜Is lymph node dissection for early gastric cancer necessary?“Yes,it is.”本胃癌腹腔镜 N0 N1 N2 N3T1(M)T1(SM)T2T3T4H1,P1,CY1,M1,AEMR(Well diff.,2.)Gastrectomy with D2AGastrectomy with D2BExtended SurgeryGastrectomy+D2AGastrectomy+D2BGastrecto
6、my+D2Extended SurgPalliative SurgChemotherapyRadiation therGuidelines for Gastric Cancer Treatment(2001)：Recommendable Mode of Treatment defined by Disease Stage (Standard Care,and本胃癌腹腔镜 N0 N1 N2 N3T1(M)T1(SM)T2T3T4H1,P1,CY1,M1,AEMR(Well diff.,2.0.)Gastrectomy with D2 (2.)Laparosopic gastrectomyGast
7、rectomy with 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)本胃
8、癌腹腔镜Advanced Cancer Strategy for GC Treatment Mucosal CancerEMRLaparoscopic SurgeryOpen Surgery(OMC 2004)Submucosal Cancer本胃癌腹腔镜Lap 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(7
9、5%)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Complications in Japanese nationwide experience of lap-DG Stomal stenosis 103/2600 (3.9)Wound infection 45/2600 (1.7)Anastomotic leakage 43/2600
10、(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55512位置位置本胃癌腹腔镜Lymph node dissection around LGE vesselsLGEVLGEV本胃癌腹腔镜Lymph node dissection around RGE vesselsGDARGEA本胃癌腹腔镜Lymph node dissection around RG vessels (
11、from anterior aspect)本胃癌腹腔镜Lymph node dissection around PHA PHA本胃癌腹腔镜Lymph node dissection around CHA,LGA,SpA and CeACHAPancreas本胃癌腹腔镜Lymph node dissection around SMV(14v)本胃癌腹腔镜当科当科Roux-Y再建手技再建手技本胃癌腹腔镜腹腔鏡下胃癌手術後腹壁傷腹腔鏡下胃癌手術後腹壁傷本胃癌腹腔镜Median Number of Retrieved Lymph Nodes,Blood Loss,and Operative Time
12、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Conclusion-LDG in generaln With recent advent of instrumentation,laparoscopic approach is increasingly applied for patients with early cancer.n 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
