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Sixty-one patients who were diagnosed with mucosal gastric cancer have been successfully treated with two laparoscopic techniques at our institute from March 1992 to March 1997. One is laparoscopic wedge resection of the stomach using a lesion-lifting method for lesions of the anterior wall, the lesser curvature, and the greater curvature of the stomach. The other is laparoscopic intragastric mucosal resection for lesions of the posterior wall of the stomach and near the cardia or the pylorus. Indications are as follows: (1) preoperatively diagnosed mucosal cancer; (2) <25 mm diameter elevated lesions; and (3) <15 mm diameter depressed lesions without ulcer formation. Patients were discharged in 4 to 8 days uneventfully. There was no major complication or mortality. The resected specimens had sufficient surgical margins horizontally (16 +/- 5 and 8 +/- 4 mm, respectively) and vertically. In one patient histologic examination revealed slight tumor infiltration into the submucosal layer with lymphatic invasion. He underwent gastrectomy with lymph node dissection 1 month after surgery. Otherwise, histologic examination revealed curative surgery. All patients in the series have survived during the 4- to 65-month follow-up period. There have been two recurrences in the series, both of which were found near the staple line 2 years after the initial surgery and were still mucosal lesions. They were successfully treated by open gastrectomy and laser irradiation. A separate early gastric cancer was found 2 years after the initial surgery in one patient, who then underwent curative open gastrectomy. In conclusion, if the patients are selected properly, these laparoscopic procedures are curative, minimally invasive treatment for early gastric cancer.

This report describes an original laparoscopic treatment for early gastric cancer with curative intent. After laparoscopic exposure of the gastric wall around a cancerous lesion, a small metal rod is introduced into the stomach at the vicinity of the lesion through a catheter which pierces the abdominal wall and the exposed gastric wall. While the cancerous lesion is lifted up precisely with the support of the metal rod, wedge resection of the stomach is carried out using an endoscopic stapling device. This procedure results in complete local resection of the lesion with a sufficient surgical margin. We have applied this method to 6 patients with mucosal gastric cancer. Postoperative courses were all uneventful, and the histology revealed they were curative resections. Provided the indication is selected properly, it could be a curative and minimally invasive treatment for early gastric cancer.

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