Clinicopathological analysis of synchronous multiple gastric carcinoma

Clinicopathological analysis was performed on 839 cases surgically resected for gastric carcinoma. The incidence of multiple gastric carcinoma was 4.8% (40 cases, 97 lesions). Multiple carcinoma was more frequently observed in early than in advanced carcinoma (P less than 0.01). The rate of intestinal type lesions was significantly (P less than 0.01) higher in multiple than in single gastric carcinoma, and all of the intestinal type carcinoma correlated with intestinal metaplasia, which is assumed to be closely related to pyloric and atrophic fundic gland area. Eight cases (20.0%) of multiple carcinoma were both in the upper one-third and lower one-third of the stomach. Twenty-nine (51.9%) of the accessory lesions were not detected pre-operatively; 12 (21.1%) of them were detected only by postoperative histology. Twelve (48.0%) of 25 early cancerous foci located in the anterior wall and greater curvature were overlooked before operation. These results indicate that the whole stomach must be carefully examined to detect accessory carcinoma before gastric surgery, especially for intestinal type carcinoma, with greater attention paid to the anterior wall and greater curvature, and that complete removal of the pyloric and atrophic fundic gland area would be required for distal gastrectomy.