Surgical local resection for early gastric cancer

In Japan, endoscopic mucosal resection remains a familiar treatment of early gastric cancers even though long-term results of surgical local resection (SLR) including a laparoscopic or open approach have been unclear. We reviewed our SLR experiences. Laparoscopic wedge resection (LWR), laparoscopic intragastric surgery (LIS), and open local resection (OLR) were performed in 11, 7, and 11 patients, respectively. Four LIS patients were converted to open surgery. Histologically, resected specimens demonstrated that larger-sized materials were obtained in OLR and LWR. Five patients overall showed submucosal invasion; 1 patient underwent reoperation (gastrectomy). Long-term results showed no primary-lesion related death; 2 patients died of other diseases. However, 2 LWR patients showed new lesions in the remnant stomach at 29 months and 7 years later. Both patients underwent subsequent gastrectomy. In conclusion, SLR is safe and curative for properly selected cancer patients. Precise preoperative diagnosis and careful remnant stomach survey is important.