LIMITED SURGERY FOR EARLY GASTRIC-CANCER IN CARDIA

Background: Because there are some difficulties with the diagnosis of invasion or the endoscopic resection technique, almost all gastric tum ors are resected surgically. Surgeons now are performing a limited ope ration for early gastric cancer of the upper stomach (EGCUS) without l ymph node metastasis. This paper discusses and evaluates the surgical technique and the results of the limited operation for EGCUS. Patients and Methods: Since 1988, a total of 34 patients with EGCUS, diagnosed as intramucosal invasion, have undergone a limited operation-fundecto my-which includes a limited proximal gastrectomy, a limited lymph node dissection, and a procedure preserving the vagal nerve. The surgical risk, postoperative complications, and survival rates of the fundectom y patients (group A) were compared with those of patients undergoing a total gastrectomy for EGCUS (group B). Results: Blood loss was lower in group A (300 +/- 193 mL) than in group B (555 +/- 316 mL) (P <.05). The incidence of postoperative pancreatic fistula also was lower in g roup A (0%) than in group B (15.0%) (P <.05). All patients in both gro ups (except one who died of a cerebral infarction) are alive without r ecurrence. Conclusion: Compared to the results of a total gastrectomy, performance of a limited fundectomy for EGCUS decreased surgical risk and postoperative complications without decreasing the survival rate.