胃肠外科GastricCancer培训课件.ppt
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胃肠外科GastricCancer培训课件.ppt

胃肠外科GastricCancer培训课件.ppt

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EpidemiologyEpidemiologyNutritionalLowfatorproteinconsumptionSaltedmeatorfishHighnitrateconsumptionHighcomplexcarbohydrateconsumptionEnvironmentalPoorfoodpreparation(smoked,salted)PoordrinkingwaterSmokingothersMedicalPriorgastricsurgeryH.pyloriinfectionGastricatrophyandgastritisAdenomatouspolypsOthersMalegenderLowsocialclassHereditaryHereditaryDiffuseGastricCancerLynchSyndromeJuvenilePolyposisSyndromePeutz-JeghersSyndromeFamilialAdenomatousPolyposisNCCN2015ver.3i)Earlygastriccancer(EGC)I:protrudedEGC:EndoscopicimagesAGC:Borrmann’sclassificationAGC:Borrmann’sclassificationAGC:Borrmann’sclassificationAGC:Borrmann’sclassificationAGC:Borrmann’sclassificationPhotomicrographsofGastricCarcinomaTstageLymph node stationMetastesisClinicalPresentationPhysicalsignsInvestigationsEndoscopyDouble-ContrastBariumUpperGIRadiographyEUSTBUSCTscanAMRI-DWIPET/CTTTreatmentforGastricCancerResectableTumorsTisorT1a------EMR/ESDT1b-T3-----Gastrectomywithnegativemicroscopicmargins(typically≥4cmfromgrosstumor)T4-----EnblocresectionofinvolvedstructuresUnresectableTumorsLocoregionallyadvancedDiseaseinfiltrationoftherootofthemesenteryorpara-aorticlymphnodehighlysuspiciousonimagingorconfirmedbybiopsyInvasionorencasementofmajorvascularstructures(excludingthesplenicvessels)Distantmetastasisorperitonealseeding(includingpositiveperitonealcytology)Principlesofradicaloperationforgastriccanceri)Negativemarginii)Extentoflymphnodedissectioniii)EnblocresectioniV)NodistantmetastasisEMRforEarliergastriccancer(EGC)CriteriaforEMRCriteriaforEMREMREMREMR1.Difficulttoresectlargethan20mmtumorinsize2.DifficulttoresectulcerativelesionsESDforEGCESDESDMinimalInvasiveSurgeryLaparoscopicResectionLaparoscopicsurgery3DLaparoscopicsurgeryDa Vinci SisurgicalsystemOpenSurgeryforAdvancedGastricCancerPrinciplesofradicaloperationGastrectomyandD2lymphadenectomyforadvancedgastriccarcinomaLymphadenectomyAnastomosisTotalgastrectomyLeftgastricAPORTALVEINLymphadectomyofgroup7,8,9Lymphadectomyofgroup11L