Abstracts
1999 Digestive Disease Week

# 2191 LAPAROSCOPIC WEDGE RESECTION OF THE STOMACH FOR EARLY CANCER AND LEIOMYOSARCOMA - RESULTS OF SIX YEARS EXPERIENCE
Yoshihide Otani, M Ohgami, M Kimata, J Tokuyama, T Kubota, K Kumai, M Kitajima, Sch of Medicine, Keio Univ, Tokyo Japan; M Mukai, Keio Univ, Tokyo Japan

Since 1992, we have successfully treated eighty-four patients with early cancer and nineteen patients with leiomyosarcoma by laparoscopic surgery. INDICATION The indication of curative local resection for early cancer is; 1) mucosal cancer, 2) T<25 mm, if the lesion is protruded lla type, 3) T<15 mm without ulcer formation, if the lesion is depressed llc type. The indication for leiomyosarcoma is; 1) 20 mm (T< 50 mm, 2) Rapid increase in size indicating malignant potential, 3) location of the tumor is not close to the cardia or pylorus. METHODS In order to achieve preoperative evaluation precisely, not only endoscopy and barium mean but also endoscopic ultrasonography were performed. All procedures were carried out laparoscopically. By grasping the intact wall of the stomach near the lesion with two clamps, the lesion was pulled up and resected with an endoscopic stapler. For mucosal gastric cancer, a ''lesion-lifting method'' (Dig. Surg. 11:64, 1994) was applied. A small metal rod with a fine wire was introduced through the abdominal wall into the stomach. By pulling the metal rod, the lesion was lifted up and resected with sufficient surgical margin. RESULTS No intraoperative complication was experienced. All specimens had sufficient distance from the lesion to any surgical margin. Patients could start diet on 1 POD and were discharged in 5-7 days uneventfully. There was no mortality and no major complication in this series. No distant metastasis or lymph node recurrence of the tumor was experienced in six-year-follow up. Laparoscopic wedge resection of the stomach for gastric malignancies can be regarded as a curative and minimally invasive procedure when it is applied for strictly selected cases.

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