Subtotal gastrectomy as treatment for distal multifocal early gastric cancer.
BACKGROUND
Multifocal early gastric cancer (MEGC) is frequently observed and represents a serious risk when minimally invasive treatments are performed.


METHODS
We present the experience of two Italian centers situated in a relatively high incidence area for gastric cancer. Out of a total of 791 surgical resections for EGC carried out in two Italian centers from 1976 to 2006, we identified 98 patients with multifocal EGC (12.3%). Two hundred and sixteen lesions were observed. Generally sited near the principal tumors, secondary lesions were, however, sometimes detected distally from the upper primary lesion. No secondary lesions were detected in the upper third when the principal lesion was sited at the lower third.


RESULTS
Survival of MEGC patients was not significantly lower than that of patients with monofocal EGC. No cases of gastric remnant relapse were observed at a mean follow-up of 9 years (range 1-28) after subtotal gastrectomy.


CONCLUSIONS
When EGCs are detected, the possibility of MEGC must always be investigated by endoscopy and chromoendoscopy. When a MEGC is found in the lower third of the stomach and chromoendoscopy of the upper third has been performed, subtotal gastrectomy can be considered as sufficient treatment.
Morgagni
Paolo
P
Department of General Surgery, Pierantoni-Morgagni Hospital, Via Forlanini 34, 47100 Forlì, Italy. p.morgagni@ausl.fo.it
Marfisi
Caterina
C
Gardini
Andrea
A
Marrelli
Daniele
D
Saragoni
Luca
L
Roviello
Franco
F
Vittimberga
Giovanni
G
Garcea
Domenico
D
D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008297:Male; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome