Synchronous multiple early gastric carcinoma: A study of 178 cases

Abstract

Over the past 3 decades, ending in 1979, resection has been performed in 7,220 patients with gastric carcinoma. Synchronous multiple gastric carcinoma, according to the diagnostic criteria of Moertel, was found in 468, of which 178 (38%) were "early." There were 135 double, 33 triple, and 10 quadruple early earcinomas. Fewer than one-third of the smaller tumors were diagnosed preoperatively, and 61.5% of the smaller lesions were less than 10 mm in diameter. In 53% of the patients, the smaller lesions were in the lower one-third of the stomach with the main lesion in the upper one-third, whereas in 13% the smaller neoplasms were iocated in the upper one-third of the stomach with the main lesion in the Iower one-third. The clinical significance of the smaller lesions was their location relative to the resection line. When planning treatment of gastric carcinoma, it is important to evaluate the whole stomach before and during the operation and after examining the resected specimen. The 5-year survival rate for patients with multiple early gastric carcinoma was 85.8%.The concept of the management of early gastric carcinoma bas evolved since the first description by Verse in 1908 [1]. Recently, we have achieved an increase in the detection of early gastric carcinoma by improved diagnosis principally due to fiberoptic instruments. In 1980 Ohta et al. [2] reported that more than one-third of the resected gastric carcinomas (108 of 277 cases) at the Cancer Institute Hospital in Tokyo were "early." The frequency of early cancer has also increased in the United States [3] and in Europe [4]. This increase has contributed significantly to the recent improvement in survival

Clinicopathological characteristics of gastric cancer in the elderly

“…The incidence of synchronous multiple cancer of the stomach has increased recently, and it now constitutes several per cent of all cancers (Moertel et al, 1957;Noguchi et al, 1985). In our study, multiple gastric cancers were found in 7.69% of the elderly and this figure is significantly higher than in the middle-aged group.…”

Early gastric cancer mimicking advanced gastric cancer

“…As these incidences have increased, the clinicopathological features of EGCs have been gradually elucidated by various authors (Mori et al, 1985;Ohta et al, 1987;Moreaux et al, 1993). The accumulation of patients with EGCs has allowed the investigation of atypical EGCs (Noguchi et al, 1985;Ichiyoshi et al, 1990; Kitamura et al, 1996a); early gastric cancers mimicking advanced gastric cancers (EGC mimicking AGC) is one such variant.…”

Subtotal Gastrectomy or ‘en principle’ Total Gastrectomy in Cancer of the Lower Half of the Stomach

“…This figure, which is very small, is intermediate between a prevalence of 2 and 8% report ed in literature [6][7][8][9][10], and it is a much lower rate than the 22% reported in advanced cancer or in the rare cases of cancer associated with pernicious anemia or multiple gastric polyposis [11,12], The most important point however is that multiple foci are always strictly contiguous to the main lesions and many of them are early gastric cancers.…”