Treatment of multiple early gastric cancer

To investigate the treatment of multiple early gastric cancer, 82 cases were compared with 829 single early gastric cancers. Univariate analyses with respect to eight clinicopathological factors--age, sex, family history of gastric cancer, macroscopic appearance, histologic type, depth of tumor invasion, tumor location, and lymph node metastasis--were performed. Age, male sex, elevated and differentiated-type tumors, frequent occurrence in the lower third, and mucosal cancers were correlated significantly with multiple early gastric cancer. However, there was no significant difference in the frequency of node involvement. Multiple early gastric cancer, limited to the mucosal layer, was not associated with node involvement. Therefore, endoscopic mucosal resection may be feasible for the treatment of multiple early gastric cancer when there is no evidence of submucosal invasion in any of the lesions and none exceed 2.0 cm in diameter. Upon examination of the long-term results for patients with multiple early gastric cancer, two (3.0%, 2/66) had died of recurrence due to hematogenous spread, and one (1.9%, 1/52) had developed cancer of the remnant stomach. Other primary malignancies were observed in 12 patients (18.2%, 12/66). In particular, lung cancer was the major neoplasm occurring after gastrectomy. These results suggest the importance of systemic surveillance for the detection of other malignancies as well as cancer of the remnant stomach and recurrence after gastrectomy for multiple early gastric cancer.