Strategy of the Treatment of Early Gastric Cancer at Matsuyama District

Akira Kurita, Yoshirou Kubo, Toshiaki Saeki, Nobuji Yokoyama, Minoru Tanada, Wataru Takiyama, Shigemitsu Takashima

Department of Surgery, National Shikoku Cancer Center Hospital

We describe our strategy for the treatment for gastric carcinoma in situ at National Shikoku Cancer Center. We have performed endoscopic mucosal resection (EMR) for depressed-type carcinomas less than 20 mm in diameter without ulcer scars. However, depressed-type carcinomas less than 20 mm in diameter and unassociated with macroscopic or microscopic regional lymph nodes metastasis have been treated by partial gastric resection with or without video-assisted approach. In cases of depressed-type carcinomas larger than 20 mm in diameter but not containing poorly differentiated adenocarcinoma, partial gastrectomy without regional lymph node dissection (D0 level) has been performed. In poorly differentiated adenocarcinoma, regardless of tumor size, partial gastrectomy with regional lymph nodal dissection (D2 level) which is our standard surgical treatment for gastric cancer, has been carried out. For the elevated type of m carcinomas, tumor less than 20 mm have been resected by EMR, and tumors larger than 20 mm have been treated by partial gastric resection or gastrectomy. When gastric stenosis has been found after gastric partial resection, we have sometimes performed additional gastrectomy without regional lymph node dissection. We histopathologically reviewed our patients treated by the above-described strategy for m carcinomas. We performed 149 EMRs for patients with m carcinomas, and 119 carcinomas were completely removed by EMR, but 7 carcinomas were not completely removed by EMR. In addition, 30 patients were initially treated by multiple resection. Five of the 149 patients treated by EMR were found to have residual cancer or recurrence in their stomach. Two of these recurrent cancer patients initially underwent incomplete EMR, and 3 patients were initially resected with multiple resection by EMR. Seventeen patients were treated by partial gastric resection with laparotomy. Five of the 17 carcinomas were sm carcinomas histologically, i.e., invasive carcinomas. Thirty-five patients were treated by partial gastrectomy associated with a video-assisted approach. Seven, 3, and 1 carcinomas were sm1, sm2 and sm3, respectively, histologically. At the present time, overall survival of the patients, treated by our strategy for m carcinoma has not been confirmed, and long-term follow-up will be needed to identify the optimal surgical treatment for these early gastric cancer patients.

Key words
early gastric cancer, endoscopic mucosal resection, wedge gastrectomy

Reprint requests
Akira Kurita Department of Surgery, National Shikoku Cancer Center Hospital
13 Horinouchi, Matsuyama, 790-0007, JAPAN

Accepted
July 22, 1998

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