Indications for Pylorus Preserving Gastrectomy for Early Gastric Cancer

Clinicopathological evaluation of lymph node metastasis was undertaken to determine the indications for pylorus preserving gastrectomy for patients with early gastric cancer. Lymph node involvement was investigated in 583 patients with early gastric cancer located in the lower and middle third of the stomach who had undergone conventional gastrectomy with D2 lymph node dissection. It is essential that this limited operation is performed in cases without metastasis to the right pericardiac and suprapyloric lymph nodes. By analysis of the relationship between lymph node metastasis and histologic type, macroscopic type, tumor size, or depth of invasion, the indications for pylorus preserving gastrectomy were determined to be as follows: (1) cases with mucosal cancer and submucosal cancer smaller than 30 mm when the histologic type is differentiated.(2) cases with mucosal cancer smaller than 30mm and submucosal cancer smaller than 10 mm when the histologic type is undifferentiated and the macroscopic type is depressed.