Local Excision for Synchronous Multiple Gastric Cancer

Zenro Nihei, Wataru Ichikawa, Masashi Ito, Toshiki Yamashita, Hiroyuki Uetake, Takayuki Osanai

Second Department of Surgery, Tokyo Medical and Dental University

One hundered cases of synchronous multiple gastric cancer, specimens of which were obtained at our department and affiliated hospital during a 15-year period, were analyzed to determine whether local excision is applicable for those cases. Accessory lesions were diagnosed by preoperative examination in 45.4% of the cases. Grossly flat lesions and small lesions tended to be missed preoperatively. In cases in which the main lesion was in the early stage, lymph node metastasis was identified in only one case in which the main lesion was infiltrating to the submucosal layer. Among 32 cases in which the accessory lesions were identified before surgery, local excision could be performed for 37.5% of the main lesions and 53.1% of the accessory lesions. Finally, 40.6% of the cases of preoperatively identified multiple early gastric cancer required gastrectomy and could not be treated by local excision, but 37.5% of the cases might be treated by endoscopic mucosal resection and/or laparoscopic local excision without performing gastrectomy. Postgastrectomy problems could be avoided even in multiple gastric cancer and the quality of life after treatment would be better. The mucosal layer in which metachronous cancer can develop will remain after local excision. Careful follow-up examination is indispensable after treatment of the lesions in multiple gastric cancers by local excision.

Key words
multiple gastric cancer, gastrectomy, local excision

Reprint requests
Zenro Nihei Second Department of Surgery, Tokyo Medical and Dental University
1-5-45 Yushima, Bunkyo-ku, Tokyo, 113 JAPAN

Accepted
June 11, 1997

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