When do we miss synchronous gastric neoplasms with endoscopy?

Lee, Hang Lak; Eun, Chang Soo; Lee, Oh Young; Han, Dong Soo; Yoon, Byung Chul; Choi, Ho Soon; Hahm, Joon Soo; Koh, Dong Hee

doi:10.1016/j.gie.2010.01.011

Cited by 52 publications

(43 citation statements)

References 15 publications

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“…However, a comprehensive evaluation using serial sections of the whole stomach revealed that it was 13-15 % [10,12], which suggests a higher incidence of latent lesions in the whole stomach [13]. If the latent lesion cannot be detected by preoperative examinations and is left in the gastric remnant, the lesion may arise as a metachronous cancer.…”

Section: Introductionmentioning

confidence: 99%

Incidence of metachronous gastric cancer in the remnant stomach after synchronous multiple cancer surgery

et al. 2013

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Background In the preoperative evaluation for gastric cancer, high-resolution endoscopic technologies allow us to detect small accessory lesions. However, it is not known if the gastric remnant after partial gastrectomy for synchronous multiple gastric cancers has a greater risk for metachronous cancer. The purpose of this study was to determine the incidence of metachronous cancer in this patient subset compared with that after solitary cancer surgery. Methods Data on a consecutive series of 1,281 patients gastrectomized for early gastric cancer from 1991 to 2007 were analyzed retrospectively. The 715 gastric remnants after distal gastrectomy were periodically surveyed by endoscopic examination in Shikoku Cancer Center. Among those surveyed cases, 642 patients were pathologically diagnosed with solitary lesion (SO group) and 73 patients with synchronous multiple lesions (MU group) at the time of the initial surgery. Results In the follow-up period, 15 patients in the SO group and 3 patients in the MU group were diagnosed as having metachronous cancer in the gastric remnant. The cumulative 4-year incidence rate was 1.9 % in the SO group and 5.5 % in the MU group. The difference did not reach the significant level by the log-rank test. ConclusionsThe incidence of metachronous cancer is higher after multiple cancer surgery; however, the difference is not statistically significant.

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Section: Introductionmentioning

confidence: 99%

Incidence of metachronous gastric cancer in the remnant stomach after synchronous multiple cancer surgery

et al. 2013

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“…Although the residual gastric mucosa after endoscopic resection is thought to be a high-risk environment, the high risk may only be the result of occult synchronous cancers [17]. Because small lesion size is the major risk factor for endoscopic failure to recognize synchronous additional gastric lesions, the entire stomach should be carefully examined, especially when ESD of gastric cancer is to be performed [10].…”

Section: Discussionmentioning

confidence: 99%

“…Accurate detection of synchronous multifocal gastric cancer is mandatory for the successful management of gastric cancer, and the entire stomach should be examined with particular care during endoscopic procedures, especially when endoscopic resections of tumors are to be performed [10].…”

Section: Introductionmentioning

confidence: 99%

Simultaneous endoscopic submucosal dissection for synchronous double early gastric cancer

et al. 2012

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Background This study aims to evaluate the safety and efficacy of simultaneous endoscopic submucosal dissection (ESD) for synchronous double early gastric cancers. Methods We retrospectively evaluated 832 single gastric cancers from 789 patients treated by single ESD (single group) and 124 synchronous double cancers from 62 patients treated by simultaneous ESD (simultaneous group). Results The overall rate of en bloc resection and curative resection was comparable between the two groups. Procedure time was significantly longer in the simultaneous group than in the single group (131.0 ± 66.5 and 94.8 ± 64.1 min, respectively, P \ 0.001). White blood cell count on the day after ESD was significantly higher in the simultaneous group (9310 ± 2774/ll) than in the single group (8633 ± 2341/ll) (P = 0.032). Length of fasting period after ESD was 1.1 ± 0.5 days in the single group and 1.4 ± 1.1 days in the simultaneous group (P = 0.082). Complications were more frequent in the simultaneous group than in the single group (11.3 vs. 5.4 %, respectively), but the difference was not significant (P = 0.082). Complication rate per one lesion did not differ between the two groups (5.6 vs. 5.4 %, respectively, P = 0.914).Multivariate analysis showed procedure time longer than 150 min was independently predictive for complications of simultaneous ESD (P \ 0.042, odds ratio = 6.094). Large tumors, upper portion location and tumors not in the standard guideline criteria were significantly associated with long procedure time. Conclusions Simultaneous ESD for synchronous early gastric cancer can be a feasible and safe option, and it can reduce hospital stay. These results need to be validated by further studies.

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“…Finally, after a single lesion is identified, careful inspection for synchronous abnormalities is necessary. In one study, preoperative gastroscopy performed by endoscopists with more than 10 years of experience failed to identify 15 % of synchronous multifocal gastric cancers found on surgically resected specimens, with the mean size of missed lesions (1.57 cm) significantly smaller than the detected ones (2.14 cm) [56].…”

Section: Diagnosismentioning

confidence: 99%