[A clinicopathological study on conservative surgery and extended surgery for gastric cancer]

There are two problems in conservative surgery for early gastric cancer. 1) To resect the stomach at a sufficient surgical margin, brushing cytodiagnosis of the gastric mucosa and frozen section examination at the stump are performed during operation. After all these examinations, the stomach is resected at a sufficient margin because of the possibility of multifocal cancer. 2) Regarding lymph node dissection, only N1 lymph nodes are to be removed in minute cancer (less than 5mm in diameter) which have no lymph node metastasis (0%). Thirty-one cases of Borrmann type 4 gastric cancer which underwent left upper abdominal evisceration plus Appleby's method (LUAE + Apl) were compared with 31 patients who had undergone total gastrectomy with pancreatico-splenectomy (TG) before LUAE + Apl series. The 3-year survival rate in stage II-III cases was higher with LUAE + Apl (77.8%) than with TG (35.0%). There was no difference between the two groups in the incidence of postoperative complications or the function after operation. Angiography must be performed before conducting operations by LUAE + Apl preventing liver necrosis. And for patients aged over 70, we propose to reduce the procedure of LUAE + Apl.