Characteristics of Metachronous Multiple Early Gastric Cancers after Endoscopic Mucosal Resection

Background and Study Aims: Endoscopic mucosal resection (EMR) of early gastric cancer is a minimally invasive procedure. The incidence and characteristics of metachronous multiple gastric cancers were investigated in a retrospective study in patients with early gastric cancer after EMR treatment.
Patients and Methods: A total of 143 patients with early gastric cancer who had undergone EMR treatment were periodically followed up with endoscopic examinations for 24 months or longer.
Results: The median period of endoscopic follow-up was 57 months (range 24 - 157 months). None of the patients died of gastric cancer, and there were no treatment-related deaths. Five patients died of other diseases. Of 20 patients (14 %) with metachronous multiple gastric cancers, 15 were treated by EMR. One patient with differentiated submucosal cancer and four with undifferentiated cancers underwent surgery. Sixteen patients (11 %) had synchronous multiple early gastric cancer lesions within 1 year of the initial EMR. About half of the multiple lesions were located in the same third of the stomach as the primary lesion, and most lesions were similar in macroscopic type to the primary lesions. Most multiple lesions were of the differentiated type.
Conclusions: Annual endoscopic examinations can preserve the whole stomach in most patients with early gastric cancer after successful EMR.

References

• 1 Tada M, Murakami A, Karita M. et al . Endoscopic resection of early gastric cancer.  Endoscopy. 1993;  25 445-450
• 2 Yamao T, Shirao K, Ono H. et al . Risk factors for lymph node metastasis from intramucosal gastric carcinoma.  Cancer. 1996;  77 602-606
• 3 Arima N, Adachi K, Katsube T. et al . Predictive factors for metachronous recurrence of early gastric cancer after endoscopic treatment.  J Clin Gastroenterol. 1999;  29 44-47
• 4 Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma, 2nd English ed.  Gastric Cancer. 1998;  1 10-24
• 5 Moertel C G, Bargen J A, Soule E H. Multiple gastric cancers: review of the literature and study of 42 cases.  Gastroenterology. 1957;  32 1095-1103
• 6 Mitsudomi T, Watanabe A, Matsusaka T. et al . A clinicopathological study of synchronous multiple gastric cancer.  Br J Surg. 1989;  76 237-240
• 7 Kaneko K, Kondo H, Saito D. et al . Early gastric stump cancer following distal gastrectomy.  Gut. 1998;  43 342-344
• 8 Sowa M, Kato Y, Onoda N. et al . Early cancer of the gastric remnant - with special emphasis on the importance of follow-up of gastrectomized patients.  Hepatogastroenterology. 1992;  39 400-404
• 9 Seto Y, Nagawa H, Muto T. Treatment of multiple early gastric cancer.  Jpn J Clin Oncol. 1996;  26 134-138
• 10 Takeda J, Toyonaga A, Koufuji K. et al . Early gastric cancer in the remnant stomach.  Hepatogastroenterology. 1998;  45 1907-1911
• 11 Hosokawa O, Kaizaki Y, Watanabe K. et al . Endoscopic surveillance for gastric remnant cancer after early cancer surgery.  Endoscopy. 2002;  34 469-473
• 12 Kosaka T, Miwa K, Yonemura Y. et al . A clinicopathologic study on multiple gastric cancers with special reference to distal gastrectomy.  Cancer. 1990;  65 2602-2605
• 13 Isozaki H, Okajima K, Hu X. et al . Multiple early gastric carcinomas. Clinicopathologic features and histogenesis.  Cancer. 1996;  78 2078-2086
• 14 Kitamura K, Yamaguchi T, Okamoto K. et al . Clinicopathologic features of synchronous multifocal early gastric cancers.  Anticancer Res. 1997;  17 643-646
• 15 Borie F, Plaisant N, Millat B. et al . Treatment and prognosis of early multiple gastric cancer.  Eur J Surg Oncol. 2003;  29 511-514
• 16 Honmyo U, Misumi A, Murakami A. et al . Clinicopathological analysis of synchronous multiple gastric carcinoma.  Eur J Surg Oncol. 1989;  15 316-321
• 17 Lee H S, Lee B L, Kim S H. et al . Microsatellite instability in synchronous gastric carcinomas.  Int J Cancer. 2001;  91 619-624
• 18 Tsukuma H, Oshima A, Narahara H. et al . Natural history of early gastric cancer: a non-concurrent, long term, follow up study.  Gut. 2000;  47 618-621
• 19 Sue-Ling H M, Martin I, Griffith J. et al . Early gastric cancer: 46 cases treated in one surgical department.  Gut. 1992;  33 1318-1322