Treatment for Multiple Early Gastric Cancer

Koichiro Kumai, Yoshihiko Sakurai, Yasunori Hoshiya, Masashi Yoshida, Yoshihide Otani, Tetsuro Kubota, Masaki Kitajima

Department of Surgery, School of Medicine, Keio University

Forty-three patients with synchronous multiple early gastric cancer were compared histopathologically with 807 patients with a single lesion. Multiple early gastric cancer was more common in elderly patients and in males. The incidence of a macroscopically elevated lesion and histologically differentiated type of adenocarcinoma in multiple early gastric cancer was higher than in cancer with a single lesion. Tumor invasion of the submucosa was observed in 67.4% of the main lesions of multiple early gastric cancer, but 86.9% of the accessory lesions were mucosal cancers. The incidence of lymph node metastasis was not higher in multiple early gastric cancer. Many lesions were located in the middle or lower part of the stomach. The modified surgery with lymph node dissection D₁ was used for 60% of the patients with multiple early gastric cancer according to the selection criteria of surgery for a single lesion. Their postsurgical survival rate revealed a good Qutocome compared to that of the patients with a single lesion. Nine synchronous and 3 metachronous multiple early gastric cancers were observed in 119 patients who underwent endoscopic treatment for early gastric cancer. Intensive examination for synchronous and metachronous cancer or adenoma should be conducted. Endoscopic mucoal resection, laparoscopic surgery, modified open surgery (D₁) or standard surgery (D₂) could be selected for multiple early gastric cancer using our selection criteria for surgery for early gastric cancer.

Key words
multiple early gastric cancer, histopathological findings, selection of surgery for multiple early gastric cancer

Reprint requests
Koichiro Kumai Department of Surgery, School of Medicine, Keio University
35 Shinanomachi, Shinjuku-ku, Tokyo, 160 JAPAN

Accepted
June 14, 1995

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