[Laparoscopic wedge resection of the stomach for early gastric cancer using a lesion-lifting-method: curative and minimally invasive treatment]

Abstract

Thirty-eight patients with early gastric cancer have been successfully treated by laparoscopic wedge resection of the stomach in our institute since March 1992. Our indication of the surgery is as follows: 1) preoperatively diagnosed mucosal cancer, 2) < 25 mm, if the lesion is elevated type, and 3) < 15 mm and no ulcer scar, if the lesion is depressed type. After laparoscopic exposure of the gastric wall around a cancerous lesion, a sheathed needle was inserted into the stomach through the abdominal wall at the vicinity of the lesion under gastroscopy guidance. A small metal rod was introduced into the stomach near the lesion through the outer sheath. While the lesion was lifted up precisely with the support of the metal rod, wedge resection of the stomach was performed using an endoscopic stapler (lesion-lifting method). Perigastric 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 diameter, and there was a sufficient surgical margin (16 +/- 5mm). All patients have survived during the 2 to 60 months follow-up period. There has been one recurrence and one separate occurence of early gastric cancer in the series, which were curatively treated by gastrectomy. Advantages of the surgery are as follows: 1) it is minimally invasive, 2) most of the stomach is preserved, 3) a sufficient surgical margin can be obtained, and 4) a detailed histologic examination is feasible. If the indication is selected properly, this laparoscopic surgery can be a curative and minimally invasive treatment for early gastric cancer.