專題討論1:微創外科手術的最新發展與應用

S1-7
Laparoscopy- Assisted Distal Gastrectomy (LADG) for Treatment of Gastric Cancer --- The experience of VGH-Kaohsiung
陳以書
高雄榮民總醫院一般外科

Although the incidence of gastric cancer has decreased world-wild, it is still an important cause of cancer-specific mortality. Surgical resection is currently the only curative treatment. However, the heterogeneity of staging system and extent of lymphadenectomy between Eastern Asia and Western countries, and it has encompassed for more than 30 years.

With the development of diagnostic instruments and increased use of screening, the incidence of early gastric cancer ( EGC ) increased gradually, especially in Japan and Korea ( 50 ~ 70 % ). Functional- preserving treatment was developed and stage-specific treatment was emphasized in last decade. LADG was established as a guideline in the treatment of selected EGC in Japan. It accounts for more than 20% gastrectomies for treatment of gastric cancer in Japan at present. LADG for early gastric cancer has already accepted in terms of postoperative benefits, such as reduced pain, earlier GI function recovery and less respiratory complication. The oncological outcome is almost confirmed in EGC, esp. in Japan and Korea. However, the safety and feasibility of laparoscopy-assisted D2 gastrectomy for respectable gastric cancer is accepted, but it lacks long-term survival results from any large-scale RCT.

The development of LADG for treatment of gastric cancer is slower in Taiwan, comparing with Japan and Korea. We share our limited experience of LADG, and call for conducting a study group.