本胃癌腹腔镜.pptxVIP

本胃癌腹腔镜第1页/共24页 02004006008001000120014009192939495969798990001Total gastrectomyProximal gastrectomyDistal gastrectomy 　　(D2 or more)Distal gastrectomy　　(D1+α)Distal gastrectomy　　 (D1)Local resectionIntragastric surgeryLaparoscopic Surgery for Gastric Cancer in Japan（year）（cases）(7th Nationwide Survey, 2004, JSES)Miscellaneous‘02’03160018002000Distal gastrectomy　　(D1+β)第2页/共24页 02004006008001000120014009192939495969798990001Total gastrectomyProximal gastrectomyDistal gastrectomy 　　(D2 or more)Distal gastrectomy　　(D1+α)Distal gastrectomy　　 (D1)Local resectionIntragastric surgeryLaparoscopic Surgery for Gastric Cancer in Japan（year）（cases）(7th Nationwide Survey, 2004, JSES)Miscellaneous‘02’03160018002000Distal gastrectomy　　(D1+β)第3页/共24页 Is lymph node dissection for early gastric cancer necessary ? 第4页/共24页 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)第5页/共24页 2.21.10.64.42.50.51.70.8Percent incidence of regional lymph node metastasis from T1(sm) cancer (M)0.32.70.9Group 1 nodesGroup 2 nodes( OMC experience in 1978 ～2000)第6页/共24页 Is lymph node dissection for early gastric cancer necessary ? “Yes, it is.”第7页/共24页 　　　 N0 　　 　　　　　　　　 N1 　 　　　　 N2 　 　　 N3T1(M)T1(SM)T2T3T4H1, P1,CY1, M1,ⅠAEMR　(Well diff., 2.0cm,UL (－) )Gastrectomy with D1+α ⅠAGastrectomy with D1+α 　(Well diff, 　＜1.5cm)Gastrectomy with D1+ βⅠBGastrectomy with D2ⅡGastrectomy with D2 ⅢAExtended Surgery ⅠBGastrectomy with D1+ β (＜2.0.ｃｍ)Gastrectomy with D2 ( 2.１.ｃｍ)ⅡGastrectomy with D2ⅢAGastrectomy with D2ⅢBExtended SurgeryⅡGastrectomy +D2ⅢAGastrectomy +D2ⅢBGastrectomy +D2ⅣExtended SurgPalliative SurgChemotherapyRadiation therGuidelines for Gastric Cancer Treatment (2001)：　Recommendable Mode of Treatment defined by Disease Stage ( Standard Care, and第8页/共24页 　　　 N0 　　 　　　　　　　　 N1