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