LAPAROSCOPIC WEDGE RESECTION OF THE STOMA CH FOR EARLY GASTRIC-CANCERUSING A LESION-LIFTING-METHOD - CURATIVE AND MINIMALLY INVASIVE TREATMENT

Thirty-eight patients with early gastric cancer have been successfully treated by laparoscopic wedge resection of the stomach in our institu te since March 1992. Our indication of the surgery is as follows: 1) p reoperatively diagnosed mucosal cancer, 3) < 25 mm, if the lesion is e levated type, and 3) < 15 mm and no ulcer scar, if the lesion is depre ssed type. After laparoscopic exposure of the gastric wall around a ca ncerous lesion, a sheathed needle was inserted into the stomach throug h the abdominal wall at the vicinity of the lesion under gastroscopy g uidance. A small metal rod was introduced into the stomach near the le sion through the outer sheath. While the lesion was lifted up precisel y with the support of the metal rod, wedge resection of the stomach wa s performed using an endoscopic stapler (lesion-lifting method). Perig astric lymph nodes could be also resected when necessary. There was no intraoperative and postoperative complication, and no mortality. The patients were discharged within 5 days after surgery uneventfully. The resected specimens were 50 to 110 mm in dia meter, and there was a su fficient surgical margin (16 +/- 5mm). All patients have survived duri ng the 2 to 60 months follow-up period. There has been one recurrence and one separate occurence of early gastric cancer in the series, whic h were curatively treated by gastrectomy. Advantages of the surgery ar e as follows: 1) it is minimally invasive, 2) most of the stomach is p reserved, 3) a sufficient surgical margin can be obtained, and 3) a de tailed histologic examination is feasible. If the indication is select ed properly, this laparoscopic surgery can be a curative and minimally invasive treatment for early gastric cancer.