Early gastric carcinoma: spread and multicentricity.
BACKGROUND
In early gastric carcinoma (EGC), after subtotal gastrectomy, recurrent lesions limited to the gastric remnant are the cause of about 20% of deaths from recurrence. Therefore, it has been suggested to perform total gastrectomy in all cases of EGC.


METHODS
We studied a case series of 82 consecutive patients operated on for an EGC, with a mean follow-up time of 72 months (range, 1-120 months). Subtotal distal gastrectomy was performed 61 patients, total gastrectomy in 15, and other procedures in 6. Outcome measures were recurrence and causes of mortality, focusing on patients with resection line involvement and multifocal lesions.


RESULTS
EGC was limited to the mucosa in 43 patients and had invaded the submucosa in 39. Ten patients had a lymph node involvement. In 4 patients having had a subtotal gastrectomy, resection line involvement was detected. In 3 patients, the involvement was detected peroperatively on frozen sections, and a re-resection was performed. In the fourth patient, the involvement was detected postoperatively, but follow-up endoscopies failed to show any residual tumor. In 17 patients, multifocal lesions were observed. No recurrence was observed in the gastric remnant of patients having undergone a subtotal gastrectomy.


CONCLUSIONS
In distal EGC, a subtotal gastrectomy may be performed under two conditions: (1) careful endoscopic and peroperative examination of the upper part of the stomach to detect multifocal lesions and (2) a systematic frozen-section assessment of the resection margin to avoid inadequate resection.
Huguier
Michel
M
Department of Digestive Surgery, Hôpital Tenon, Paris VI University, 4 rue de la Chine, 75020 Paris, France.
Ferro
Leonardo
L
Barrier
Alain
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000556:secondary; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D010297:Paris; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome