1 / 29

State-of-the-art in the Surgical Treatment of Gastric Cancer in Shanghai

State-of-the-art in the Surgical Treatment of Gastric Cancer in Shanghai. Department of Surgery Rui Jin Hospital School of Medicine, SJTU. Overall morbidity is declining Absolute number of pts is large Newly diagnosed GC in Shanghai > 6000 /Yr

ursula
Télécharger la présentation

State-of-the-art in the Surgical Treatment of Gastric Cancer in Shanghai

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. State-of-the-art in the Surgical Treatment of Gastric Cancer in Shanghai Department of Surgery Rui Jin Hospital School of Medicine, SJTU

  2. Overall morbidity is declining Absolute number of pts is large Newly diagnosed GC in Shanghai > 6000 /Yr Biological behavior is more aggressive in recent cases Epidemiology of Gastric Cancer in Mainland China & In Greater Shanghai

  3. The morbidity & mortality of GC in Shanghai ( 2006 ) Male Female 在男性发病率与死亡率均居第 2位，在女性分别居第 3 与第 2位 -- Shanghai CDC, 2007--

  4. Gastro- enterology Digestive Surgery Gastric Cancer Clinical Nutrition Radiology Pathology Chemo-radiation Institute of Digestive Surgery Multi-disciplinary Collaboration for GC Research in RJ Hospital (since 2005)

  5. Translational Research to Improve the Outcome of Gastric Cancer Patients • New Techniques for early diagnosis of gastric cancer • Pre-operative staging • Intra-operative peritoneal hyperthermic chemotherapy（IPHC） • Multi-modality treatment of gastric cancer according to different stages

  6. New Techniques for Early GC Screening • Symptomatic screening for high-risk population • Morphological study to delineate early gastric cancer and benign lesions • Early gastric cancer detected by fluorescence • Gastroscopy coupled with con-focal microscopy

  7. 2005-2008 Percentage of EGC in Operated GC Patients (1996～2008, RJ Hospital) Percentage of EGC in 2005-2008 : 21.6％ WU YL, et al.2007

  8. 40-Yr Experience in the Surgical Treatment of Gastric Cancer in Rui-Jin Hospital

  9. Clinical MaterialsJan. 1960 – Dec. 2000 Cases Admitted 4370 Cases Operated 3958 90.6% Cases Resected 3013 76.1% Cases Followed 3625 91.6%

  10. No. of Resected Cases Entering into Study • Cases Analyzed 2703 • Cases Excluded 310 • Lost to Follow-Up • Accidental Death • Multiple Cancers • PTX, PNX or MX • Rate of Exclusion 10.0%

  11. Staging & 5-Yr Survival

  12. Staging & 5-Yr Survival

  13. Overall Survival Rate 1960 - 2000 • Cases Resected 2703 • 5-Yr Survivors 1107 • 5-Yr SR 41.0%

  14. 1960-1983 vs 1984-2000

  15. Ratios of Different Stages in 2 Periods 1960-1983 1984-2000

  16. 5-Year SR During the 2 Periods % 1960-1983 1984-2000

  17. 5-Yr Survival Rate (1984-2000 Series) Radical Resection 1047 • 5-Yr Survivors 661 • Survival Rate 63.1% Palliative Resection 481 • 5-Yr Survivors 63 • Survival Rate13.1% • Overall 5-Yr SR47.4% (724/1528)

  18. Improvement of Results Due to • Increase in ratio of Early & Middle-Stage cases • Close follow-up of high risk persons • Close cooperation between Gastroenterologists & Surgeons • Probing new parameters • Adoption of a more rational strategy

  19. EGC ( Ia Ib ) Aims Radicalness QOL Procedures m-Ca Limited Resection EMR ESD D1 sm-Ca D2

  20. Middle Stage( II IIIa ) Aims Radicalness Procedures ● Pre-op Staging Endoscopy EUS CT & Computerized Assessment ●Multimodality Therapy Neo-adjuvant Chemo--- Radical Op--- D2, D3 EPIC / IPHC

  21. D2 1 7 3 9 12a 11p 8a 9 9 5 4d 4d 6 4d D1 14v the extent of standard lymph node dissection in radical gastrectomy LD/L

  22. A comparative study on the efficacy of spleen- preserving modified D2 radical gastrectomy and D2 radical gastrectomy with splenectomy n = 61 cases n = 51 cases • n = 51 cases n = 61 cases -- Yao XX, Zhu ZG, 2010

  23. A comparative study on the efficacy of splee-preserving modified D2 radical gastrectomy and D2 radical gastrectomy with splenectomy Conclusion: The efficacy of modified D2 radical total gastrectomy with spleen-preserving for patients with gastric cancer in the upper third, upper and middle third or entire stomach is similar to that of D2 radical total gastrectomy with splenectomy, and the spleen-preserving procedure is associated with decreased postoperative complication and improved survival. -- Yao XX, Zhu ZG, 2010

  24. IPHC Procedure • Double-pump closed-circuit circulation ; volume：5-6 L • Thermo-control：water-bath, 43.0℃±1.0℃ • Input Temperature: 44.0℃~45.0℃ • Output Temperature: 40.0℃~42.0℃ • Velocity: 500 ~ 800 ml/min • 4 sites for thermo-detector • Duration：1h • Chemo-agents: CDDP 50mg/L，MMC 5mg/L ZHU ZG et al., 2006

  25. Overall Survival Rates ZHU ZG et al., 2006

  26. Survival Benefits of Prophylactic IPHC ZHU ZG et al., 2006

  27. Survival Benefits of Therapeutic IPHC P<0.05 ZHU ZG et al., 2006

  28. Late Stage ( IIIb IV ) Aims Prolong SR & QOL Procedures Cyto-reductive Op If Feasible Multi-Modality Therapy

  29. Thanks

More Related