| [ Summary ] |
We have successfully treated 53 patients with early gastric cancer, using two different laparoscopic procedures, since March 1992. The procedures are laparoscopic wedge resection of the stomach using a lesion-lifting method (n=36) and laparoscopic intragastric mucosal resection (n=17). The indications are as follows : (A) mucosal cancer, (B) <25mm, if the lesion is the protruding type, (C) <15mm and Ul(-), if the lesion is the depressive type. The advantages of these methods are ; 1) minimal invasiveness, 2) sufficient surgical margin, 3) feasibility of detailed histology, 4) feasibility of perigastric lymph node dissection. However, several problems remain to be solved ; 1) preoperative diagnostic accuracy of the depth of cancer invasion, 2) possibility of reoperation because of sm invasion or lymphatic or venous invasion on final histological examination, 3) possibility of postoperative stenosis after laparoscopic intragastric mucosal resection for lesions near the cardiac, and the incidence of metachronous multiple gastric cancer. In conclusion, if appropriate indications are applied, these laparoscopic procedures constitute a curative and minimally invasive treatment for early gastric cancer. |