Treatment of Primary Multiple Early Gastric Cancer: From the Viewpoint of Clinicopathologic Features

Abstract

The treatment of multiple early gastric cancer was investigated through the clinicopathologic assessment of 61 cases of primary multiple early gastric cancer (82 accessory lesions) treated by surgical resection over a 15-year period. These cases accounted for 11.7% of all cases of early gastric cancer resected during the same period. The 61 patients included 48 men (mean age 64 years) and 13 women (61 years). Of the 82 accessory lesions, 41 (50%) were located in the same region as the main lesion. The most frequent combination of macroscopic types of the main lesion and the accessory lesion was depressed type/depressed type (28 cases). The main lesion was of the well differentiated type in 39 (64%) of the 61 cases; the accessory lesion was also well differentiated in 37 of the 39 cases. Of the 82 accessory lesions, 29 (35%) had been overlooked preoperatively; most of them were located in the middle third of the stomach and included 17 depressed and 10 flat lesions, most of which measured no more than 1 cm. Cases of multiple early gastric cancer are characterized by the predominance of male patients of advanced age (> 60 years), a combination of the same macroscopic type of the main and accessory lesions, and well differentiated carcinoma. Lymph node metastasis and vascular invasion are equally or less frequent than in cases of solitary early gastric cancer. The postoperative crude survival rate in patients with multiple gastric cancer is similar to that in those with solitary gastric cancer. Therefore we believe that multiple early gastric cancer does not require extended operative procedures. Endoscopic treatment may be indicated if each lesion fits the criteria for treatment and careful follow-up is ensured.

BGP expression in gastric biopsies may predict the development of new lesions after local treatment for early gastric cancer

“…We agree with both the opinion that "the surgeon is required to resect the area including the F-line at the time of distal gastrectomy so as not to leave another cancer in the gastric remnant" [15] and the opinion that "the treatment of multiple gastric cancer does not require extended operative procedure, and EMR may be indicated if each lesion fits the criteria for treatment and careful follow-up is ensured" [31]. The important thing is to have a good predictor for metachronous recurrence after local treatment [8,25].…”

Senkron mide ve kolon kanseri: Olgu sunumu

“…Erken evre mide kanseri s›kl›¤› ve mide kanserli hastalar›n sa¤ kal›m sürelerinin artt›¤› göz önü-ne al›nd›¤›nda, mide kanseri olan ve risk faktörleri mevcut olan hastalara (ileri yafl, erken evre diferansiye mide kanseri) preoperatif dönemde senkron kanser aç›s›ndan ileri tetkikler uygulanmal›d›r. Senkron kanser tespit edildi¤i takdirde erken evre mide kanserinin prognozu ileri evre kanserden çok daha iyi oldu¤undan ve senkron bir kanserden etkilenebilece¤in-den, mümkün olabildi¤ince efl zamanl› operasyon uygulanmal›d›r (7,8). Postoperatif dönemde metakron kanser aç›s›n-dan hastalar yak›n takip edilmelidir.…”

Update on Surgery of Gastric Cancer: New Procedures versus Standard Technique

“…The revolutionary point of this technique is that not only a polypoid but also a depressed mucosal lesion can be removed along with the surrounding normal mucosa, which provides suffi cient material for histological confi rmation of tumor cell infi ltration. After successful EMR, however, close follow-up of the patient by endoscopy is mandatory, because multifocal lesions, either synchronous or metachronous, are not uncommon in the stomach [18] . A second or third lesion will again be removed by EMR if it satisfi es the above criteria.…”