抄録
Early cancers in the body of the stomach are often accompanied by shallow IIc or analogous IIb in their margins, and determination of the extent of tumor infiltration is difficult in many cases. Determination of the extent of tumor infiltration is most important in selection of the therapeutic approach. We examined 87 cases of early cancer and early-cancer-like advanced cancer in the body of the stomach to increase the accuracy of endoscopic diagnosis. The diagnosis by the dye (indigo carmine) spray method was difficult in differentiated cancer of the lesser curvature showing marked atrophy of the marginal mucosa, and the marginal region of cancer must be examined most carefully in such cases. From the viewpoint of the quality of life, total gastrectomy should be avoided as much as possible in early stomach cancer. We determined the distance from esophago cardiac junction (ECJ) by endoscopic clipping and performed subtotal gastrectomy in 14 cases by modification of the resection method. The cut-off distance between total and subtotal gastrectomies for lesions located primarily in the lesser curvature was 4 cm, and total gastrectomy was considered to have been unnecessary in 8 (10.5%) of the 76 cases of early cancer of the body of the stomach that underwent total gastrectomy. Endoscopic clipping appears to be useful for determination of the extent of gastrectomy for early cancer of the stomach.
