Multiple synchronous early gastric cancers: High-risk group and proper management

In Seob Lee, Young Su Park, Kab Choong Kim, Tae Hwan Kim, Hee Sung Kim, Kee Don Choi, Gin Hyug Lee, Jeong Hwan Yook, Sung Tae Oh, Byung Sik Kim

Research output: Contribution to journalReview article

10 Citations (Scopus)

Abstract

Background: Multiple early gastric cancers (MEGCs) may be easily missed on preoperative gastroscopy because the lesions are predominantly small and flat. This may increase the risks of gastric remnant lesions and recurrence. We aimed to define high-risk group of MEGC and suggest proper management of missed lesion after partial gastrectomy. Methods: A total of 117 patients with MEGCs and 2182 with solitary EGC who underwent gastrectomy between 2008 and 2010 were retrospectively analyzed to determine their clinicopathologic characteristics. We also assessed their family history, the presence of Helicobacter pylori infection, and of precancerous lesions; and the results of microsatellite instability and immunohistochemical staining of the primary (largest) lesion for p53, human epidermal growth factor receptor [HER1], and HER2 were also reviewed. Results: MEGCs occurred more frequently in elderly males and in patients with adenoma, atrophic gastritis, or a family history of gastric cancer. These patients had more favorable pathologic findings, including less deep invasion, better differentiation, more intestinal type, and less frequent lymphovascular/perineural invasion than patients with solitary EGCs. The mean size of MEGCs was smaller (2.44 cm vs 3.36 cm) but there was no difference in the number of metastatic lymph nodes. Most accessory lesions were confined to the mucosal layer, with their average diameter was 1.82 cm. Conclusions: A careful preoperative gastroscopy should be performed in patients at high risk of MEGCs and more cautious postoperative endoscopic surveillance of the remnant stomach is required. For missed foci on remnant stomach, endoscopic resection can be a good option if it meets the criteria.

Original languageEnglish
Pages (from-to)269-273
Number of pages5
JournalSurgical oncology
Volume21
Issue number4
DOIs
StatePublished - 1 Dec 2012

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Stomach Neoplasms
Gastric Stump
Gastroscopy
Gastrectomy
Atrophic Gastritis
Microsatellite Instability
Helicobacter Infections
Epidermal Growth Factor Receptor
Helicobacter pylori
Adenoma
Lymph Nodes
Staining and Labeling
Recurrence

Keywords

  • Accessory lesion
  • Endoscopic resection
  • High-risk group
  • Multiple early gastric cancers

Cite this

Lee, I. S., Park, Y. S., Kim, K. C., Kim, T. H., Kim, H. S., Choi, K. D., ... Kim, B. S. (2012). Multiple synchronous early gastric cancers: High-risk group and proper management. Surgical oncology, 21(4), 269-273. https://doi.org/10.1016/j.suronc.2012.08.001
Lee, In Seob ; Park, Young Su ; Kim, Kab Choong ; Kim, Tae Hwan ; Kim, Hee Sung ; Choi, Kee Don ; Lee, Gin Hyug ; Yook, Jeong Hwan ; Oh, Sung Tae ; Kim, Byung Sik. / Multiple synchronous early gastric cancers : High-risk group and proper management. In: Surgical oncology. 2012 ; Vol. 21, No. 4. pp. 269-273.
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Lee, IS, Park, YS, Kim, KC, Kim, TH, Kim, HS, Choi, KD, Lee, GH, Yook, JH, Oh, ST & Kim, BS 2012, 'Multiple synchronous early gastric cancers: High-risk group and proper management', Surgical oncology, vol. 21, no. 4, pp. 269-273. https://doi.org/10.1016/j.suronc.2012.08.001

Multiple synchronous early gastric cancers : High-risk group and proper management. / Lee, In Seob; Park, Young Su; Kim, Kab Choong; Kim, Tae Hwan; Kim, Hee Sung; Choi, Kee Don; Lee, Gin Hyug; Yook, Jeong Hwan; Oh, Sung Tae; Kim, Byung Sik.

In: Surgical oncology, Vol. 21, No. 4, 01.12.2012, p. 269-273.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Multiple synchronous early gastric cancers

T2 - High-risk group and proper management

AU - Lee, In Seob

AU - Park, Young Su

AU - Kim, Kab Choong

AU - Kim, Tae Hwan

AU - Kim, Hee Sung

AU - Choi, Kee Don

AU - Lee, Gin Hyug

AU - Yook, Jeong Hwan

AU - Oh, Sung Tae

AU - Kim, Byung Sik

PY - 2012/12/1

Y1 - 2012/12/1

N2 - Background: Multiple early gastric cancers (MEGCs) may be easily missed on preoperative gastroscopy because the lesions are predominantly small and flat. This may increase the risks of gastric remnant lesions and recurrence. We aimed to define high-risk group of MEGC and suggest proper management of missed lesion after partial gastrectomy. Methods: A total of 117 patients with MEGCs and 2182 with solitary EGC who underwent gastrectomy between 2008 and 2010 were retrospectively analyzed to determine their clinicopathologic characteristics. We also assessed their family history, the presence of Helicobacter pylori infection, and of precancerous lesions; and the results of microsatellite instability and immunohistochemical staining of the primary (largest) lesion for p53, human epidermal growth factor receptor [HER1], and HER2 were also reviewed. Results: MEGCs occurred more frequently in elderly males and in patients with adenoma, atrophic gastritis, or a family history of gastric cancer. These patients had more favorable pathologic findings, including less deep invasion, better differentiation, more intestinal type, and less frequent lymphovascular/perineural invasion than patients with solitary EGCs. The mean size of MEGCs was smaller (2.44 cm vs 3.36 cm) but there was no difference in the number of metastatic lymph nodes. Most accessory lesions were confined to the mucosal layer, with their average diameter was 1.82 cm. Conclusions: A careful preoperative gastroscopy should be performed in patients at high risk of MEGCs and more cautious postoperative endoscopic surveillance of the remnant stomach is required. For missed foci on remnant stomach, endoscopic resection can be a good option if it meets the criteria.

AB - Background: Multiple early gastric cancers (MEGCs) may be easily missed on preoperative gastroscopy because the lesions are predominantly small and flat. This may increase the risks of gastric remnant lesions and recurrence. We aimed to define high-risk group of MEGC and suggest proper management of missed lesion after partial gastrectomy. Methods: A total of 117 patients with MEGCs and 2182 with solitary EGC who underwent gastrectomy between 2008 and 2010 were retrospectively analyzed to determine their clinicopathologic characteristics. We also assessed their family history, the presence of Helicobacter pylori infection, and of precancerous lesions; and the results of microsatellite instability and immunohistochemical staining of the primary (largest) lesion for p53, human epidermal growth factor receptor [HER1], and HER2 were also reviewed. Results: MEGCs occurred more frequently in elderly males and in patients with adenoma, atrophic gastritis, or a family history of gastric cancer. These patients had more favorable pathologic findings, including less deep invasion, better differentiation, more intestinal type, and less frequent lymphovascular/perineural invasion than patients with solitary EGCs. The mean size of MEGCs was smaller (2.44 cm vs 3.36 cm) but there was no difference in the number of metastatic lymph nodes. Most accessory lesions were confined to the mucosal layer, with their average diameter was 1.82 cm. Conclusions: A careful preoperative gastroscopy should be performed in patients at high risk of MEGCs and more cautious postoperative endoscopic surveillance of the remnant stomach is required. For missed foci on remnant stomach, endoscopic resection can be a good option if it meets the criteria.

KW - Accessory lesion

KW - Endoscopic resection

KW - High-risk group

KW - Multiple early gastric cancers

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DO - 10.1016/j.suronc.2012.08.001

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