Surgical treatment of gastric cancer

By | January 2, 2012

Method of choice for early gastric cancer is surgery. Based on years of clinical research on early gastric cancer has gradually removed from the so-called radical tendency to over-restrictive surgery, and the emergence of endoscopic resection of early gastric membrane Bo (EMR), laparoscopic resection of early gastric cancer limited methods such as surgical resection for the treatment of early gastric cancer has opened up many new avenues. Commonly used in clinical gastric surgical procedures are:
Gastric surgery method (1) endoscopic mucosal resection
Endoscopic resection of early gastric cancer is relatively easy to teach film, the mortality rate is low, the main stripping current biopsy method, double snare polypectomy method, epinephrine injection excision, resection of a transparent cap to teach film and so on. EMR as the treatment of early gastric cancer has been recognized, the indications are:
protruded lesions (IIa) 2cm range, or depressed lesions (IIC) <lcm range of marks is not epilepsy, because very little of this type of lymph node metastasis, surgical resection with the same effect;
Bo cancer invasion limited to the film;
well differentiated type (intestinal);
the elderly and infirm who refused surgery;
a contraindication to surgical complications.
Endoscopic resection of conjunctiva are common complications of bleeding and perforation rates were between 9.1% and 0.9%. If found not RMR radical surgery specimen (refer to positive margin) or to the deep infiltration or vascular invasion, should be further radical surgery, a supplementary laparotomy. Recurrence after EMR if 80% of patients in 1 year, EMR careful postoperative endoscopic follow-up is extremely important, and some cases of recurrence of the line can be re-EMR, and some need surgery.
Surgical treatment of gastric cancer (2) reduce the surgical local excision
With the increase in the rate of early diagnosis of gastric cancer, the way the surgical treatment of breast cancer and other tumors, have a step by step by the so-called radical surgery trends in the transition to restrictive procedures. Gastric restrictive surgery earlier indication of open and laparoscopic surgery is similar to surgical methods are similar. Only full-gastrectomy stomach 1/2–1/3 range, lymph node dissection for gastric cancer lymph nodes, incomplete resection omentum. Total gastrectomy in multiple indications and limited (foci distributed in the stomach district) and the residual early gastric cancer. There will pylorus preserving distal gastrectomy used in early gastric cancer.
Surgical treatment of gastric cancer (3) laparoscopic surgery
According foci should not be used because of size or location of EMR, can be used laparoscopic surgery or stomach surgery stomach lining and other foci. The former by raising the lesions using endoscopy to remove cancer, gastric anastomosis for anterior wall, lesser curvature and greater curvature of the early gastric cancer; the latter exposed through the stomach inflated foci, complete fulguration in the laparoscopic resection of endometrial cancer, for posterior wall, close to spray the door and pyloric lesion.
Early gastric restrictive procedures, indication if the right choices, you can achieve good cure rates. Compared with the standard radical gastrectomy, such operations retained the appetite function, help maintain the stability of structure and function of the digestive tract, thereby reducing the postoperative complications and improve nutrient absorption, improve patient quality of life, especially for the older body weak patients.

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