Modified Surgery for Early Gastric Cancer

Koichiro Kumai, Yoshiro Saikawa, Shinji Ogawa, Yoshihide Ohtani, Masahiro Ohgami, Tetsuro Kubota, Masaki Kitajima

Department of Surgery, School of Medicine, Keio University

Lymph node metastases were observed in only 11/456 patients (2.4%) with mucosal gastric cancer in our department. Since 1977 we have used modified surgery for mucosal gastric cancer. Our modification is 2/3 gastrectomy with D₁+No.7 lymph node dissection in contrast with subtotal or total gastrectomy with D₂ lymph node dissection of standard surgery. Although high long-term survival rates were observed in the modified surgery group, the postsurgical quality of life (QOL) was not sufficient as compared with the standard surgery group. Endoscopic mucosal resection (EMR) gave good QOL, but the rates of complete resection of the lesions around 2 cm in diameter were about 70%. We though that the majority of mucosal cancers could be curatively treated by local resection of the stomach. Four patients were successfully treated by laparoscopic wedge resection in a minimally invasive procedure. Our slection of surgery for early gastric cancer is as follows: 1. Standard open surgry (D₂) for a lesion invading the submucosal layer. 2. Modified surgery for mucosal cancer; 1) EMR for a lesion less than 1 cm in diameter, 2) laparoscopic wedge resection for an elevated lesion less than 2.5 cm and for a depressed lesion less than 2 cm combined with absence of an ulcer scar, 3) modified open surgery (D₁) for other mucosal cancers.

Key words
modified surgery for early gastric cancer, laparoscopic wedge resection of the stomach, endoscopic mucosal resection

Reprint requests
Koichiro Kumai Department of Surgery, School of Medicine, Keio University
35 Shinanomachi, Shinjuku-ku, Tokyo, 160 JAPAN

Accepted
December 8, 1993

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