Laparoscopic gastrectomy for cancer
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Laparoscopic gastrectomy for cancer
Laparoscopic gastrectomy Elena Orsenigo MD, FACS Department of Surgery University Vita-Salute San Raffaele Milan Treatment guidelines for gastric cancer JGCA Standard gastrectomy: more than 2/3 gastrectomy+ D2 dissection, splenectomy is optional Modified gastrectomy: either less than 2/3 gastrectomy or less than D2, mod α: D1+no7 mod β: D1+ No 7, 8a, 9 Pylorus preserving gastrectomy, vagal nerve preservation, partial omental preservation are options Evaluation of curability Criteria for the extent of a possibly curable gastric carcinoma include: No involvement of the proximal and distal margins, with no less than 10 mm proximal and distal distances Sufficient lymph node dissection, with no fewer than 15 lymph nodes dissected Laparoscopic surgery for gastric cancer Laparoscopic assisted distal gastrectomy for gastric cancer Treatment indications according to the clinical stage Japanese Association Gastric Cancer 2001 Minimally invasive treatment for gastric cancer Endoscopic mucosal resection Endoscopic submucosal resection Laparoscopic surgery -lesion-lifting (Ohgami’s method) -intragastric surgery Advanced laparoscopic surgery -pylorus preserving gastrectomy -laparoscopic-assisted distal gastrectomy -laparoscopic-assisted total gastrectomy Laparoscopy Assisted Gastrectomy Early Distal Gastric Cancer Advanced Distal Gastric Cancer Early or Advanced Proximal Gastric Cancer Surgery for gastric diseases (1987- September 2010; n=1800) San Raffaele Scientific Institute-Milan Benign disease benigna 250 1550 Malignant disease maligna Surgery for malignant gastric disease (1987- September 2010; n=1550) San Raffaele Scientific Institute-Milan laparoscopic 260 1290 laparotomic Surg Endosc. 2010 Jun 10 Surg Endosc. 2010 Jun 10 Surg Endosc. 2010 Jun 10 Surg Endosc. 2010 Jun 10 Surg Endosc. 2010 Jun 10 Surg Endosc. 2010 Jun 10 Surg Endosc. 2010 Jun 10 Surg Endosc. 2010 Jun 10 Is there a role of minimally invasive surgery in the treatment of gastric cancer? Minimally invasive surgery 25 percent 20 15 10 5 0 0 IA IB II II IA I IIB IV U IC C s ta g e Stage distribution surgically treated gastric cancer patients San Raffaele Scientific Institute (n=1424) Is there a role of minimally invasive surgery in the treatment of gastric cancer? Multidisciplinary treatment 25 percent 20 15 10 5 0 0 IA IB II II IA I IIB IV U IC C s ta g e Stage distribution surgically treated gastric cancer patients San Raffaele Scientific Institute (n=1424) Conclusions •LG for gastric tumors is an evolving technique but seems safe and feasible •LG is oncological adequate in terms of lymph node harvesting and R0 resection •LG is time consuming but associated with earlier postoperative recovery and less pain •The majority of the studies regard early and distal gastric cancers •LG for advanced disease remains a contentious issue •Cost-benefit issue of LG vs OG is yet another area that requires urgent attention Impossibile v isualizzare l'immagine. La memoria del computer potrebbe essere insufficiente per aprire l'immagine oppure l'immagine potrebbe essere danneggiata. Riav v iare il computer e aprire di nuov o il file. Se v iene v isualizzata di nuov o la x rossa, potrebbe essere necessario eliminare l'immagine e inserirla di nuov o. “My God, Jim, we can’t leave him in the hands of 20th century medicine. Those butchers will use needles and knives and cut open his belly and chest. It is still the dark ages. You have no idea what those barbarians will do.” Dr. James McCoy Starship Enterprise Star Date 2394.3