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1、 Clinical Roundsin General Surgery .Gastric carcinoma.Although its incidence in developed countries has declined, gastric cancer remains one of the most common human malignancies.background Today, we will reviews the modern approach to gastric cancer using the treatment guidelines published by UICC
2、and JGCA.GL aim to provide a standard indication for doctors to select the proper treatments of gastric cancer according to the clinical stages of patients.Purpose of Guideline.Kernel of the GuidelineTNM stagingStage-oriented treatment.Divisions of the stomach Basic knowledge about Gastric carcinoma
3、 .The stomach is reflected cephalad Blood supply to the stomach and duodenum .Tumor Location.Gross classificationsuEarlygastriccarcinoma：definedasaprimarylesionconfinedtothemucosa and submucosal layer with or without lymph modemetastasis. D 10mm is named little gastric cancer，DN，resectedresected lym
4、phonodeslymphonodes beyond beyond metastaticmetastatic lymphonodeslymphonodes；no cancer no cancer cells can be fund within 1cm of cells can be fund within 1cm of cuttingborder; a radical operation with good a radical operation with good effect and high radical degreeeffect and high radical degree de
5、finition of radical degree.BandB：D=N，orcancercellcanbefoundwithin1cmofcuttingborder;radicaloperation，butbandAismuchbetterthanitinthatofradicaldegreeandeffectBand C：resectionoflesionandpartialmetastaticfocusonly;remainofcancercell;non-radicaloperation.4wayofgastrectomyoperation1）partialgastrectomy2）p
6、roximalsubtotalgastrectomy3）extensiveradicaloperationofgastriccancer:radicalsubtotal gasrectomyortotal gasrectomyincludebodyandtailofpancrese、spleenspleen4） compound organs resection refers toresectionwithliverortranscolonetc5）mini-traumaoperationofgastriccarcinomainrecentyears.SurgicaltreatmentAppr
7、oachesnIntraluminal endoscopynLaparoscopynLaparotomynThoraco-laparolomynOthersOperative proceduresnMucosectomynWedge resectionnSegmental resectionnProximal gastrectomynPylorus preserving gastrectomynDistal gastrectomynTotal gastrectomyOther resectionnBypass without resectionnExploratory laparotomynG
8、astrostomy or other stoma fomationnOther palliative operationsCombined resection.oSymptomsoffatigue,dyspepsia,lightweightlossoranemiainpatientsover40yearsrequirediligentexaminationtoruleoutgastriccancer.oPatientswithprecursorsofgastriccancer(adenomatousployps,achlorydria,atrophicgastritis)requirerou
9、tinefollow-upandtreatment.oRoutineandcombinedapplyofuppergastrointestinalx-ray,gastroscopyandbiopsyineverypatientswhoaresuspectedtohavegastriccancer.DIAGNOSIS.An example of subtotal gastrectomy and adequate lymphadenectomy.Numbers in yellow indicate lymph node stations which should be removed and those in white indicate lymph nodes which will be left in situ.
