Problems Concerning Multiple Gastric Cancers in Gastric Conservative Surgery

Kentaro Inoue, Yasushi Nakane, Hitoshi Iiyama, Mutsuya Sato, Syunitiro Okumura, Keiji Akehira, Koshiro Hioki, Noriko Sakaida^* and Akiharu Okamura^*

2nd Department of Surgery and Department of Pathology^*, Kansai Medical University

Recently, as the range of gastric resection has been reduced, the problem of multiple gastric cancers has received a great deal of attention. The incidence of multiple gastric cancers has been reported to be around 20% in some facilities, and in our department as well, multiple gastric cancers were found in 17.3% of patients with early gastric cancer and 8.1% of those with advanced gastric cancer. The mean age of patients with multiple gastric cancers was 64.5 years, and the ratio of men to women was 7 to 1, showing a significantly higher incidence in elderly men compared with that of solitary gastric cancer. Histology showed a well differentiated tubular adenocarcinoma in many cases. The accuracy of preoperatively diagnosing the presence of accessory lesions was as low as 53.4%. The accessory lesions missed preoperatively were examined by multivariate analysis. As a result, accessory lesions were frequently missed when the depth of the accessory lesion was shallow, there was no elevated lesion, the accessory lesion was near the main lesion or the depth of the main lesion was deep. The accessory lesions were frequently located in the M or A areas, suggesting that surgical techniques preserving more areas in the M or A areas can lead to a higher frequency of residual gastric cancer due to missing multiple gastric cancer sites.

Key words
limited operation for gastric cancer, multiple gastric cancers, residual gastric cancer

Reprint requests
Kentaro Inoue 2nd Department of Surgery, Kansai Medical University 10-15 Fumisono, Moriguchi, 570-8507 JAPAN

Accepted
April 28, 1999

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