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1、Japanese Experience of Laparoscopic Oncologic Gastrectomy,Nobuhiko Tanigawa, MD, FACS and Kyoichi Takaori, MD,Department of General and Gastroenterological Surgery Osaka Medical College, Osaka, Japan,At Peking University April 6th 2005,0,200,400,600,800,1000,1200,1400,91,92,93,94,95,96,97,98,99,00,0
2、1,Total gastrectomy,Proximal gastrectomy,Distal gastrectomy (D2 or more),Distal gastrectomy (D1+),Distal gastrectomy (D1),Local resection,Intragastric surgery,Laparoscopic Surgery for Gastric Cancer in Japan,（year）,（cases）,(7th Nationwide Survey, 2004, JSES),Miscellaneous,02,03,1600,1800,2000,Distal
3、 gastrectomy (D1+),0,200,400,600,800,1000,1200,1400,91,92,93,94,95,96,97,98,99,00,01,Total gastrectomy,Proximal gastrectomy,Distal gastrectomy (D2 or more),Distal gastrectomy (D1+),Distal gastrectomy (D1),Local resection,Intragastric surgery,Laparoscopic Surgery for Gastric Cancer in Japan,（year）,（c
4、ases）,(7th Nationwide Survey, 2004, JSES),Miscellaneous,02,03,1600,1800,2000,Distal gastrectomy (D1+),Is lymph node dissection for early gastric cancer necessary ?,0.9,0.9,0.7,2.7,3.3,0.5,5.2,0.8,Percent incidence of regional lymph node metastasis from T1(sm) cancer (L),0.9,Group 1 nodes,Group 2 nod
5、es,( OMC experience in 1978 2000),2.2,1.1,0.6,4.4,2.5,0.5,1.7,0.8,Percent incidence of regional lymph node metastasis from T1(sm) cancer (M),0.3,2.7,0.9,Group 1 nodes,Group 2 nodes,( OMC experience in 1978 2000),Is lymph node dissection for early gastric cancer necessary ?,“Yes, it is.”,N0 N1 N2 N3,
6、T1(M) T1(SM) T2 T3 T4 H1, P1, CY1, M1,A EMR (Well diff., 2.0cm,UL () ) Gastrectomy with D1+ A Gastrectomy with D1+ (Well diff, 1.5cm) Gastrectomy with D1+ B Gastrectomy with D2 Gastrectomy with D2 A Extended Surgery,B Gastrectomy with D1+ (2.0.) Gastrectomy with D2 ( 2.) Gastrectomy with D2 A Gastre
7、ctomy with D2 B Extended Surgery, Gastrectomy +D2 A Gastrectomy +D2 B Gastrectomy +D2, Extended Surg Palliative Surg Chemotherapy Radiation ther,Guidelines for Gastric Cancer Treatment (2001)： Recommendable Mode of Treatment defined by Disease Stage ( Standard Care, and,N0 N1 N2 N3,T1(M) T1(SM) T2 T
8、3 T4 H1, P1, CY1, M1,A EMR (Well diff., 2.0cm,UL () ) Gastrectomy with D1+ Laparosopic gastrectomy A Gastrectomy with D1+ (Well diff, 1.5cm) Gastrectomy with D1+ Laparosopic gastrectomy B Laparosopic gastrectomy Gastrectomy with D2 Gastrectomy with D2 A Extended Surgery,B Gastrectomy with D1+ (2.0.)
9、 Gastrectomy with D2 ( 2.) Laparosopic gastrectomy Gastrectomy with D2 A Gastrectomy with D2 B Extended Surgery, Gastrectomy +D2 A Gastrectomy +D2 B Gastrectomy +D2, Extended Surg Palliative Surg Chemotherapy Radiation ther,Guidelines for Gastric Cancer Treatment (2001)： Recommendable Mode of Treatm
10、ent defined by Disease Stage ( Standard Care, and Investigational Treatment),Advanced Cancer,Strategy for GC Treatment,Mucosal Cancer,EMR,Laparoscopic Surgery,Open Surgery,(OMC 2004),Submucosal Cancer,Lap Gastrectomy for Early Cancer ( 1,622 cases in 21 leading institutions),Wedge Resection 96 (6%),
11、Inragastric Resection 35 (2%),Total Gastrectomy 66(4%),Distal Gastrectomy 1,218 (75%),Pylorus Preserving Gastrectomy 131 (8%),Proximal Gastrectomy 76 (5%),(Lap Study Group funded by Jp Ministry of Health, Welfare and Labor September, 2004),Complications in Japanese nationwide experience of lap-DG,St
12、omal stenosis 103/2600 (3.9) Wound infection 45/ 2600 (1.7) Anastomotic leakage 43/ 2600 (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 (%),5,5,5,12,位置,Lymph node dissection around LGE vessels,LGEV,LGEV,Lymph
13、 node dissection around RGE vessels,GDA,RGEA,Lymph node dissection around RG vessels (from anterior aspect),Lymph node dissection around PHA,PHA,Lymph node dissection around CHA, LGA, SpA and CeA,CHA,Pancreas,Lymph node dissection around SMV(14v),当科Roux-Y再建手技,腹腔鏡下胃癌手術後腹壁傷,Median Number of Retrieved
14、Lymph Nodes, Blood Loss, and Operative Time 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,Conclusion-LDG in general,With recent advent of instrumentation, laparoscopic approach is increasingly applied for patients with early cancer. 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.,