Diagnosis and Surgical Treatment of Early Gastric Cancer classified to the Superficial Spreading Type.

These five cases with S. S. C. of early gastric cancer are presented emphasizing that in order to get good results the preoperative examinations should be done repeatedly in detail around (a cancer lesion appearing as) an erosive part, ulcer or lowcer elevated lesion of the gastric wall by x-ray and endoscopic examinations especially biopsy and cytological examination. It is extremely important that in the early stage of gastric cancer correct diagnosis is made and the region of resection by operation is correctly determined. The surgeon should be accustomed to determine the borders of the gastric resection by the hardness of the region with cancerous infiltration. However early gastric cancer is usually not so hard. The extent of the cancerous lesion on the oral side should be decided by macroscopical observation following gastrotomy or by endoscopical biopsy before operation, especially in S. S. C. The authors have found S. S. C. in 20% of early gastric cancer. Moreover we have also reported in the author's papers that multiple gastric cancer were found in about 4% of cases with early gastric cancer. In the case with multiple gastric cancers the determination of the oral side for the resection should be decided very carefully. Therefore it is extremely important for surgeons to become skillful in preoperative diagnosis and in the macroscopic inspection on mucosal changes and on surface of the resected stomach in gastrotomy. This ability should be fully utilized in deciding the correct line of gastric resection in operation.