胃癌根治术流超声刀ppt课件.pptxVIP

胃癌根治术流+超声刀课件 胃癌根治术 2 STAGE GROUPING Stage 0 Tis NO M0 Stage 1A T1 NO MO Stage IB T1 N1 M0 T2a/b NO MO Stage lI T1 N2 M0 T2a/b N1 M0 T3 NO M0 Stage II IA T2a/b N2 M0 T3 N1 M0 T4 NO MO Stage IIIB T3 N2 M0 Stage IV T4 N1-3 M0 T1-3 N3 M0 Any T Any N M1 3 From AJCC Cancer Staging Manual, 6th ed. New York, Springer-Verag, 2001. 医科大学事一附属压况普外丹 Staging v Rowne Hompm Staging -- T T T₂ T₃ T₄ Mucosa Submucosa Muscularis propria Serosa 京医科大学事一附属压况普外丹 Contiguous structures 4 Staging -- N · TNM system AJCC and UJCC N有不同的分类方法 -1997:距肿瘤的距离：3cm:N1; 1997- :转移淋巴结的个数(15):6: N1,7-15:N2; 日本分类：根据淋巴结分站 · R status - R0-microscopically negative margin - R1-micro+,gross- -R2-gross residual disease 5 nu Pownee Ho 医科大学不一附属医况普外释 10 AJCC: 20 2 19 12a 8p 15 14a 16 前京医科大学第一时属医院善外科 - Jiangsu Prownce Hosplal 6 Surgical Treatment · Cardia proximal: · Proximal -Total gastrectomy or proximal resection? 肃京医科大学第一时属医院善外科 gastric —- Jiangsu Prvince Hosa 7 -Buhl, et al. · Gastroesophageal Reflux , heartburn, reduced appetite -Norwegian Stomach Ca Trial · Prox. gastrectomy morbid / mortal 52% 16% ·Total gastrectomy morbid / mortal 38% 8% · Total gastrectomy considered procedure of choice for proximal gastric lesions 8 —- Jiangsu Province Hospital 前京医科大学第一时属医院善外得 Proximal / Cardia · Proximal Gastrectomy- increased morbidity / mortality 前京医科大学第一时属医院善外得 Distal Tumors -No 5-year survival difference b/n subtotal vs total gastrectomy -Subtotal appropriate if negative margins -Recurrence vs nonrecurrence depends on margin of 3.5 cm vs 6.5 cm —- Jiangsu Prowince Hospltal 9 Extended Lymphadenectomy · Controversial -Japanese system ·D1 - group 1 LN ·D2 - groups 1 2 ·D3