title: Subtotal gastrectomy as treatment for distal multifocal early gastric cancer.
abstract: 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.
authors: Department of General Surgery, Pierantoni-Morgagni Hospital, Via Forlanini 34, 47100 Forlì, Italy. p.morgagni@ausl.fo.it
authors: Paolo
authors: P
authors: Morgagni
authors: Caterina
authors: C
authors: Marfisi
authors: Andrea
authors: A
authors: Gardini
authors: Daniele
authors: D
authors: Marrelli
authors: Luca
authors: L
authors: Saragoni
authors: Franco
authors: F
authors: Roviello
authors: Giovanni
authors: G
authors: Vittimberga
authors: Domenico
authors: D
authors: Garcea
mesh_terms: 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