Segmental gastrectomy for early cancer in the mid-stomach.
OBJECTIVE
We modified the surgical procedure for segmental gastrectomy, which is normally used for peptic ulcers, to treat early gastric cancer of the mid-stomach. In this paper, we describe the surgical technique and its results.


METHODS
The location of the tumor was confirmed by intra-operative endoscopic examination. An area 2 cm proximal and distal to the tumor was marked with sutures. Firstly, the lymph nodes were dissected from around the perigastric and along the left gastric and common hepatic arteries. Then, a segmental gastrectomy was performed. The greater omentum, omental sac, and vagal nerve, including the hepatic, pyloric and celiac rami, were left intact. An end-to-end gastrogastrostomy was performed using Gambee's sutures and 4-0 monofilament polydioxanone. Gastric drainage was not necessary.


RESULTS
We performed segmental gastrectomies on 30 patients. Tumors less than 1 cm in diameter were found in 4 patients; 1.1-2 cm in 14, 2.1-5 cm in 11, and a tumor exceeding 5.1 cm in one patient. The cancer was confined to the mucosa in 23 patients; in the other 7, it had penetrated the submucosa. No lymph node metastases were found but 2 patients had microscopic invasion or permeation of the lymphatic vessels. One patient required post-operative balloon dilation of the pyloric sphincter for delayed gastric emptying. The remaining patients had no post-operative complications. To date, 29 patients, excluding one who died in a traffic accident, have survived disease-free for a mean of 30 months (range: 7-51). Their body weight and dietary volume returned to pre-operative levels within 12 months of surgery.


CONCLUSIONS
Patients who underwent segmental gastrectomy have had a reasonably good quality of life in the post-operative follow-up to date.
Ohwada
S
S
Second Department of Surgery, Gunma University School of Medicine, Showa-Machi, Japan. sohwada@sb.gunma-u.ac.jp
Nakamura
S
S
Ogawa
T
T
Izumi
M
M
Tanahashi
Y
Y
Sato
Y
Y
Ikeya
T
T
Iino
Y
Y
Morishita
Y
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa / Q000473:pathology; D005773:Gastroscopy; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011178:Postgastrectomy Syndromes / Q000209:etiology / Q000628:therapy; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome