[Modified operation for early gastric cancer; rationale, technic and results]

During 1964 to 1976, standard operation, which consisted of subtotal or total gastric resection, extended dissection of lymph node and omentobursectomy, was performed for early gastric cancer. The result was satisfactory, i.e., 5 year relative survival rate was 95.2 per cent. But there were very few lymph-node metastases, which localized almost perigastric, no marked infiltration into the esophagus in cases of early cancer in the cardiac region. Macroscopic determination about the margin of the cancer was well compatible with microscopic one. The recurrent cases seemed to be due to hematogenous metastasis. These suggest that an extended lymph-node dissection, omentobursectomy and thoracotomy are not necessary for the early cancer. Proximal gastric resection and pylorus preserving gastric resection were indicated in some cases. In addition, the diagnosis of the early cancer, especially about the depth of invasion into the gastric wall, was accurate except for the early cancers which contained ulcerous lesion. Since 1977 modified operation for the early cancer has been applied. At this operation, lymph-node dissection was limited to perigastric region, omentobursectomy was omitted and the pancreas and spleen preserved. Through this method the operative time and blood unit have been much spared and the 5 year postoperative relative survival rate has improved, i.e., 100 per cent. It is concluded that the modified operation should be performed for the early gastric cancer.