1995 Volume 28 Issue 10 Pages 2097-2101
A clinicopathologic analysis of 155 patients (369 lesions) with primary multiple gastric cancers was carried out to investigate the prevalence of multiple gastric cancers in recent years and their current clinical problems. The 155 patients underwent gastrectomy and/or local resection of their lesions between 1961 and 1993 and accounted for 6.8% of 2, 284 patients with primary gastric cancer in that period. The incidence of patients with multiple gastric cancers in the recent 13 years (1981-1993) increased about 5.7-fold over that in the earlier 20 years (1961-1989): 13.7% (121/884) vs 2.4% (34/1, 400) (p<0.01). The prevalence of multiple gastric cancers was especially marked in patients over the 7th and 8th decades with an incidence of 15.0% and 19.4% respectively. The lesions were often dispersed in the stomach. A great majority of them were differentiated adenocarcinomas: 66.5& (103/155) for the main lesions and 86.4% (185/214) for the minor lesions. Of the minor lesions, 154 (72.0%) were intramucosal and 80 (37.4%) were as small as less than 10 mm in their maximal diameter. Sixty-eight patients (56.2%) in the recent 13 years had multiple superificial carcinomas and 26 (21.5%) among them had multiple intramucosal lesions. The overall diagnostic accuracy for the minor lesions was as low as 46.6% by barium swallow and 63.0% by endoscopy, and was still quite unsatisfactory even in the recent 13 years. Gastrectomy with D2-lymphadenectomy had been conventionally performed and achieved a favorable outcome with a 67.2% cumulative 5-year survival rate. Limited surgery and/or endoscopic surgery should be considered hereafter as treatment modalities, especially for elderly patients with multiple small intramucosal carcinomas. However improvement in diagnostic accuracy for multiple lesions, especially minor ones, in the stomach is mandatory.
