title: Missed lesions in synchronous multiple gastric cancer.
abstract: BACKGROUND
  The aims of this study were to define differences between synchronous multiple gastric cancer (MGC) and solitary gastric cancer (SGC) and to evaluate the characteristics of missed lesions in MGC so as to improve the detection rate of missed lesions during perioperative procedure.
  
  
  METHODS
  The authors retrospectively analysed data on 9157 gastric cancer patients who underwent gastrectomy for gastric cancer in a single hospital. The characteristics of 8893 SGC and 264 MGC patients were evaluated. The characteristics of missed lesions in MGC were compared with those of diagnosed lesions found in preoperative endoscopy.
  
  
  RESULTS
  Of the 9157 gastric patients, 264 patients with MGC showed a total of 565 cancer lesions, 70 of which were missed at endoscopy. The patients with MGC demonstrated different characteristics compared with those with SGC in terms of sex, age, type of operation, depth of tumour, lymph node metastasis, tumour size, tumour location and curability (P < 0.05). The characteristics of the missed lesions (n = 70) were a small size (P < 0.05), a middle one-third location (P < 0.001) and a flat type by macroscopic examination (P < 0.05) as compared with detected lesions (n = 495). No survival difference was detected between patients with and without missed lesions over a mean follow-up of 36.0 +/- 22.7 month.
  
  
  CONCLUSIONS
  Preoperative gastroscopy should be performed meticulously in the entire stomach, especially in older men, in order to identify the presence and locations of cancer lesions that might otherwise be missed.
authors.affiliation: Department of Surgery, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: Tae Kyung
authors.initials: TK
authors.lastname: Ha
authors.forename: Ji Yeong
authors.initials: JY
authors.lastname: An
authors.forename: Ho Geun
authors.initials: HG
authors.lastname: Youn
authors.forename: Min Gew
authors.initials: MG
authors.lastname: Choi
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Noh
authors.forename: Tae Sung
authors.initials: TS
authors.lastname: Sohn
authors.forename: Sung
authors.initials: S
authors.lastname: Kim
mesh_terms: D003951:Diagnostic Errors; D005260:Female; D005743:Gastrectomy; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000601:surgery; D016019:Survival Analysis