Annals of Surgical Oncology

, Volume 19, Issue 4, pp 1251–1256 | Cite as

Multifocality in Early Gastric Cancer Does not Increase the Risk of Lymph Node Metastasis in a Single-Center Study

  • Hee Man Kim
  • Hyun Ki Kim
  • Sang Kil Lee
  • Jae Hee Cho
  • Kyung Ho Pak
  • Woo Jin Hyung
  • Sung Hoon Noh
  • Choong Bai Kim
  • Yong Chan Lee
  • Si Young Song
  • Young Hoon Youn
Gastrointestinal Oncology

Abstract

Background

The multifocality rate of EGC ranges from 4 to 20%, but there are few data regarding both lymph node metastasis and feasibility of the endoscopic treatment. We investigated the risk of lymph node metastasis with the purpose to evaluate the potential for endoscopic treatment in patients with multifocal EGC.

Methods

We retrospectively reviewed the medical records of patients who underwent radical gastrectomy to treat EGC between January 2001 and December 2007 at Severance Hospital, Seoul, Korea. Synchronous multifocal EGC was defined as EGC having two or more malignant foci, whereas solitary EGC was defined as EGC having single focus.

Results

Of 1,693 patients, 55 (3.2%) were diagnosed with synchronous multifocal EGC. The rates of lymph node metastasis were 12.7% in synchronous multifocal EGC and 10% in solitary EGC. In the multivariate analysis, synchronous multifocal EGC was not associated with lymph node metastasis (odds ratio, 1.1; 95% confidence interval, 0.4–2.7) compared with solitary EGC. In a subgroup analysis of 55 patients with synchronous multifocal EGC, older age (≥65 years) and lymphovascular invasion were associated with lymph node metastasis. In synchronous multifocal EGC, none of the cases had lymph node metastasis in major and minor lesions representing mucosal cancer without lymphovascular invasion.

Conclusions

Synchronous multifocality of EGC does not increase the risk of lymph node metastasis compared with solitary EGC. Therefore, endoscopic treatment can be planned when major and minor lesions are predicted to represent mucosal cancer without lymphovascular invasion.

Keywords

Endoscopic Submucosal Dissection Early Gastric Cancer Endoscopic Treatment Lymphovascular Invasion Signet Ring Cell Carcinoma 

Notes

Acknowledgment

This research was supported (Jae Hee Cho) by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2011-0013944).

References

  1. 1.
    Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer. 2007;10:1–11.PubMedCrossRefGoogle Scholar
  2. 2.
    Otsuji E, Kuriu Y, Ichikawa D, Okamoto K, Hagiwara A, Yamagishi H. Clinicopathologic characteristics and prognosis of synchronous multifocal gastric carcinomas. Am J Surg. 2005;189:116–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Honmyo U, Misumi A, Murakami, Haga Y, Akai M. Clinicopathological analysis of synchronous multiple gastric carcinoma. Eur J Surg Oncol. 1989;15:316–21.PubMedGoogle Scholar
  4. 4.
    Seo JH, Park JC, Kim YJ, Shin SK, Lee YC, Lee SK. Undifferentiated histology after endoscopic resection may predict synchronous and metachronous occurrence of early gastric cancer. Digestion. 2010;81:35–42.PubMedCrossRefGoogle Scholar
  5. 5.
    Moertel CG, Bargen JA, Soule EH. Multiple gastric cancers: review of the literature and study of 42 cases. Gastroenterology. 1957;32:1095.PubMedGoogle Scholar
  6. 6.
    Morgagni P, Marfisi C, Gardini A, Marrelli D, Saragoni L, Roviello F, Vittimberga G, Garcea D; Italian Research Group for Gastric Cancer. Subtotal gastrectomy as treatment for distal multifocal early gastric cancer. J Gastrointest Surg. 2009;13:2239–44.PubMedCrossRefGoogle Scholar
  7. 7.
    Borie F, Plaisant N, Millat B, Hay JM, Fagniez PL, De Saxce B; French Associations for Surgical Research. Treatment and prognosis of early multiple gastric cancer. Eur J Surg Oncol. 2003;29:511–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Noguchi Y, Ohta H, Takagi K, Ike H, Takahashi T, Ohashi I, Kuno K, Kajitani T, Kato Y. Synchronous multiple early gastric carcinoma: a study of 178 cases. World J Surg. 1985;9:786–93.PubMedCrossRefGoogle Scholar
  9. 9.
    Japanese Gastric Cancer Association. Japanese Classification of Gastric Carcinoma, 2nd English ed. Gastric Cancer. 1998;1:10–24.PubMedCrossRefGoogle Scholar
  10. 10.
    Hölscher AH, Drebber U, Mönig SP, Schulte C, Vallböhmer D, Bollschweiler E. Early gastric cancer: lymph node metastasis starts with deep mucosal infiltration. Ann Surg. 2009;250:791–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Takeshita K, Tani M, Honda T, Saeki I, Kando F, Saito N, Endo M. Treatment of primary multiple early gastric cancer: from the viewpoint of clinicopathologic features. World J Surg. 1997;21:832–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Lee HL, Eun CS, Lee OY, Han DS, Yoon BC, Choi HS, Hahm JS, Koh DH. When do we miss synchronous gastric neoplasms with endoscopy? Gastrointest Endosc. 2010;71:1159–65.PubMedCrossRefGoogle Scholar
  13. 13.
    Kitamura K, Yamaguchi T, Okamoto K, Otsuji E, Taniguchi H, Hagiwara A, Sawai K, Takahashi T. Clinicopathologic features of synchronous multifocal early gastric cancers. Anticancer Res. 1997;17:643–6.PubMedGoogle Scholar
  14. 14.
    Mitsudomi T, Watanabe A, Matsusaka T, Fujinaga Y, Fuchigami T, Iwashita A. A clinicopathological study of synchronous multiple gastric cancer. Br J Surg. 1989;76:237–40.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Hee Man Kim
    • 1
    • 2
  • Hyun Ki Kim
    • 3
  • Sang Kil Lee
    • 4
  • Jae Hee Cho
    • 1
    • 2
  • Kyung Ho Pak
    • 5
  • Woo Jin Hyung
    • 5
  • Sung Hoon Noh
    • 5
  • Choong Bai Kim
    • 5
  • Yong Chan Lee
    • 4
  • Si Young Song
    • 4
  • Young Hoon Youn
    • 1
    • 6
  1. 1.Department of Internal Medicine, Graduate SchoolYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Division of Gastroenterology, Department of Internal MedicineKwandong University College of MedicineGoyangRepublic of Korea
  3. 3.Department of PathologyYonsei University College of MedicineSeoulRepublic of Korea
  4. 4.Division of Gastroenterology, Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
  5. 5.Department of SurgeryYonsei University College of MedicineSeoulRepublic of Korea
  6. 6.Division of Gastroenterology, Department of Internal MedicineGangnam Severance Hospital, Yonsei University College of MedicineSeoulRepublic of Korea

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