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

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Presentation on theme: "State-of-the-art in the Surgical Treatment of Gastric Cancer in Shanghai Department of Surgery Rui Jin Hospital School of Medicine, SJTU."— 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 Epidemiology of Gastric Cancer in Mainland China & In Greater Shanghai 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

3 The morbidity & mortality of GC in Shanghai ( 2006 ) 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 Mal e Female -- Shanghai CDC,

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

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 典型病例

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

9 40-Yr Experience in the Surgical Treatment of Gastric Cancer in Rui-Jin Hospital

10 Clinical Materials Jan – Dec Cases Admitted 4370 Cases Operated % Cases Resected % Cases Followed %

11 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%

12 Staging & 5-Yr Survival

13

14 Overall Survival Rate Cases Resected Yr Survivors Yr SR 41.0%

15 vs

16 Ratios of Different Stages in 2 Periods

17 5-Year SR During the 2 Periods %

18 5-Yr Survival Rate ( Series) Radical Resection 1047  5-Yr Survivors 661  Survival Rate 63.1% Palliative Resection 481  5-Yr Survivors 63  Survival Rate 13.1%  Overall 5-Yr SR 47.4% (724/1528)

19 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

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

21 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

22 the extent of standard lymph node dissection in radical gastrectomy D1 4d4d 4d4d 4d4d D2 11p 12a 14v a 9 7 LD/L

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

24 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

25 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

26 Overall Survival Rates ZHU ZG et al., 2006

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

28 IPHCControl Median Survival 10 mos 5 mos 95% Confident- scale 7-20 mos 4-9mos P<0.05 Survival Benefits of Therapeutic IPHC ZHU ZG et al., 2006

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

30 Thanks


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