Limited surgery for early gastric cancer

The prognosis of the resected "early gastric cancer" is very good, especially in mucosal cancer. In Japan, the surgery for the gastric cancer generally is subtotal gastrectomy combined with R2-lymph nodal dissection. But, some cases are free of lymph nodal metastasis, and might be cured without its dissection. We analyzed resected specimens of early gastric cancer pathologically, and assessed what cancers we could do the limited operation without impairing curability. Lymph nodal metastasis of the mucosal cancer developed 2.1% of all 291 mucosal cancers, and of the submucosal cancer, 15.7% of 229 cases. Lymph vessel permeation depicted 5.2% and 82.1%, respectively. As for the mucosal cancer, less than 10 mm in maximum diameter, there were no lymph vessel permeations nor lymph nodal metastasis. In these cases, the limited operation, especially the local resection and the endoscopic resection could be available without any fear of cancer residue. In contrast, the submucosal cancer was not considered the candidate of the limited surgery.