本胃癌腹腔镜.ppt

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 01 Total gastrectomy Proximal gastrectomy Distal gastrectomy 　　(D2 or more) Distal gastrectomy 　　(D1+α) 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 gastrectomy　　(D1+β) 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+α) 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 gastrectomy　　(D1+β) 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 nodes ( 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 T1(M) T1(SM) T2 T3 T4 H1, P1, CY1, M1, ⅠA EMR 　(Well diff., 2.0cm,UL (－) ) Gastrectomy with D1+α ⅠA Gastrectomy with D1+α 　(Well diff, 　＜1.5cm) Gastrectomy with D1+ β ⅠB Gastrectomy with D2 Ⅱ Gastrectomy with D2 ⅢA Extended Surgery ⅠB Gastrectomy with D1+ β (＜2.0.ｃｍ) Gastrectomy with D2