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Early gastric carcinoma: spread and multicentricity
Michel Huguier1, Leonardo Ferro, Alain Barrier
1Department of Digestive Surgery, Hôpital Tenon, Paris VI University, 4 rue de la Chine, 75020 Paris, France.
Summary
Subtotal gastrectomy for early gastric carcinoma (EGC) is safe if careful examination detects multifocal lesions and resection margins are clear. This approach avoids recurrence in the gastric remnant.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Oncology
Background:
- Early gastric carcinoma (EGC) poses a recurrence risk after subtotal gastrectomy, with gastric remnant lesions causing significant mortality.
- Total gastrectomy is often recommended for EGC to mitigate this risk.
Purpose of the Study:
- To evaluate the safety and efficacy of subtotal gastrectomy in distal EGC.
- To identify conditions under which subtotal gastrectomy can be safely performed for EGC.
Main Methods:
- A case series of 82 patients with EGC undergoing surgery was analyzed.
- Follow-up averaged 72 months, assessing recurrence and mortality.
- Surgical procedures included subtotal gastrectomy (61 patients) and total gastrectomy (15 patients).
Main Results:
- No recurrence was observed in the gastric remnant among patients who underwent subtotal gastrectomy.
- Resection line involvement was detected in 4 patients after subtotal gastrectomy, with 3 managed by re-resection.
- Multifocal lesions were identified in 17 patients.
Conclusions:
- Subtotal gastrectomy is a viable option for distal EGC.
- Careful endoscopic and peroperative evaluation is crucial to detect multifocal lesions.
- Systematic frozen-section assessment of resection margins is essential to prevent inadequate resections.