Indications for Laparoscopic Curative Surgery for Early Gastric Cancer, with Different Indications for Endoscopic Mucosal Resection Yoshihide Otani 1 1Department of Surgery, School of Medicine, Keio University Keyword: 早期胃癌 , 腹腔鏡下手術 , 内視鏡的粘膜切除術 pp.1121-1128
Published Date 1996/8/25
DOI https://doi.org/10.11477/mf.1403104228
  • Abstract
  • Look Inside
  • Cited by

 The detection rate of early gastric cancer has been increased by an established screening system and popularization of the videoendoscope. Local resection for early gastric cancer can be accepted as curative only in cases where there is 1) no lymph node metastasis,2) resectability with sufficient surgical margin,3) availability of histopathological investigation of the resected specimen. From these standpoints, our indication for curative local resection is as follows ; 1) mucosal cancer,2) ≦25 mm, if the lesion is the protruded type,3) ≦15 mm and ulcer (-), if the lesion is the depressed type. Laparoscopic surgery can be applied in these cases, but endoscopic mucosal resection (EMR) should be applied only in selected cases such as cancers smaller than 10 mm in diameter and, histologically, welldifferentiated type.

 We have successfully treated 40 patients with early gastric cancer by using two different laparoscopic procedures since March 1992. These procedures are laparoscopic wedge resection of the stomach using a lesionlifting method (n=25) and laparoscopic intragastric mucosal resection (n=15) . All patients were discharged within 4-8 days uneventfully. The resected specimens were 66±16 mm and 48±8 mm in diameter respectively, and had a sufficient surgical margin horizontally and vertically. Histology revealed they were all curative surgeries except for one case in whom an additional gastrectomy with lymph node dissection by laparotomy was required one month after surgery because lymphatic invasion had been revealed by pathology.

 In conclusion, endoscopic and laparoscopic treatment for early gastric cancer should be applied only for selected cases after precise preopertive evaluation.

Copyright © 1996, Igaku-Shoin Ltd. All rights reserved.


電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院