Multimodality of Treatment for Early Gastric Cancer -Retrospection of the Treatment Transition-

Yoshiki Hiki

Department of Surgery, Kitasato University School of Medicine

Looking back over the 25-year history of the therapy for the early gastric cancer in the Department of Surgery, Kitasato University School of Medicine, the standard operation was extended resection (D₂) in the early years, while limited resection (D₁+No.7 lymphadenectomy) or endoscopic surgeryb has been performed in recent years. The postoperative course, especially the incidence of complications, was investigated in patients who underwent various types of surgery from the standard operation by laparotomy to limited resection. The incidence of ileus after the standard operation was found to be worth attention. Endoscopic mucosal resection (EMR), the first choice of treatment in recent years, is an excellent method which enables histopathological evaluation of therapeutic effects. Because of the difficulty in operative technique, however, unsatisfactory results of EMR have been reported with the rate of complete resection by one operation ranging about 70%, depending on the institution. In our institution, the rate was increased to 100% by combining EMR with laser irradiation which had been performed in cases of nonresectable early gastric cancer. The most important point in the low-invasive treatment of early gastric cancer is to perform minimally invasive surgery as thoroughly as possible with the aim of leaving no residual cancer cells in the body. When such treatment is not indicated, laparotomy should be considered, to achieve a high level of curability. Cansidering the characteristics of cancer, halfway measures must be avoided.

Key words
early gastric cancer, lymphnode metastasis, endoscopic mucosal resection, laser endoscopy, laparoscopic surgery

Reprint requests
Yoshiki Hiki Department of Surgery, Kitasato University School of Medicine
2-1-1 Asamigadai, Sagamihara, 228-0828 JAPAN

Accepted
December 3, 1997

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