Indications for laparoscopic surgery for early gastric cancer

General indications for laparoscopic partial gastrectomy for early gastric cancer are : (1) Very low possi-bility of lymph node metastases, and (2) Endoscopic mucosal resection (EMR) is technically difficult to apply due to the size or the site of the lesion. We determined our definite indications, from an analysis of lymph node metastases in patients with early gastric cancer who underwent gastrectomy with lymph node dissection, as follows : (1) preoperatively diagnosed mucosal cancer, (1) < 25 mm diameter elevated lesions ; and (3) < 15 mm diameter depressed lesions without ulcer formation. On the other hand, the general indication for laposcope-assisted distal gastrectomy is lesions where the possibility of lymph node metastases is limited to the first group and a part of the second group, but we have not reached consensus concerning definite indications for such sugery. The gastric cancer treatment guidelines (GL) issued by The Japanese Gastric Cancer Association categorized laparoscopic surgeries as optional treatments for early gastric cancer and described indications. It is necessary to explain sufficiently the advantages and disadvantages of each treatment, when surgeons are going to offer laparoscopic surgery to patients with early gastric cancer. This will assure that patients can choose other available treatments including modified open gastrectomy, which is recommended as a standard treatment in GL, and EMR, which is also categorized as a optional treatment in GL.