The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

Clinicopathlogic characteristics of multiple synchronous early gastric cancers

다발성 동시성 조기위암에 대한 임상적 고찰

Kim, Hoi-Jin;Lee, Jun-Haeng;Lee, June-Sang;Moon, Tae-Gun;Kim, Jae-J.;Rhee, Jong-Chul;Noh, Jae-Hyung;Sohn, Tae-Sung;Kim, Sung
김회진;이준행;이준상;문태건;김재준;이종철;노재형;손태성;김성

  • Published : 20070400
⟨ Previous Next ⟩

Abstract

Background : With the progress of limited surgery and endoscopic treatment for early gastric cancer (EGC), multiple synchronous EGCs, a cause of recurrence, become more important. The objective of this study was to elucidate the characteristics of multiple synchronous EGCs with an emphasis on features of preoperatively undiagnosed lesions. Methods : We retrospectively reviewed medical records of 496 patients who underwent a gastrectomy for EGC at our institution between January 2004 and December 2004. Results : Twenty-four patients (4.8%) had multiple synchronous EGCs with 24 main and 27 accessory lesions. Multiple synchronous EGCs showed male predominance (p=0.03). Other characteristics including lymph node metastasis were the same as with single EGC. Out of 27 accessory lesions, six lesions (22%) were not detected preoperatively in six patients (25%). Macroscopically five lesions were flat and one lesion was depressed. Five lesions were located at the anterior or posterior wall of the middle and low third portion and one lesion was located at the lesser curvature side of the upper third portion of the stomach. Two lesions were 4 mm, one lesion was 8 mm, two lesions were 12 mm and one lesion was 15 mm in size (mean diameter = 9.1 mm). Histologically, four lesions were of the differentiated type and two lesions were of the undifferentiated type. Conclusions : Multiple synchronous EGCs have same clinicopathologic features as a single EGC except for male predominance. Considering the possibility of a synchronous lesion, one should examine the entire stomach precisely with special attention to the anterior, posterior wall and lesser curvature side of the same or neighboring area of a known EGC lesion before treatment.

목적 : 조기위암에 대한 치료로 제한적 위 절제술과 내시경적 점막 절제술의 발전과 함께 재발의 원인 중 하나로 알려진 다발성 동시성 조기위암에 대한 이해가 중요해지고 있다. 본 연구에서는 다발성 동시성 조기위암의 임상적, 병리학적 특성과 수술 전 진단되지 못했던 동시성 병변들의 특징을 알아보고자 하였다. 방법 : 2004년 1월부터 12월까지 삼성서울병원에서 조기위암으로 수술한 496예들을 수술 후 조직 검사 결과에 따라 단일 조기위암과 다발성 동시성 조기위암 두 군으로 나누어 임상적, 병리학적 특성을 다발성 조기위암을 중심으로 비교 분석하였고, 수술 전 검사에서 발견하지 못했던 병변들의 특징을 분석하였다. 결과 : 다발성 동시성 조기위암은 24예(4.8%)에서 발생하였고, 총 24개의 주병변과 27개의 부병변이 발견되었다. 다발성 동시성 조기위암은 남성에서 호발하였다(p=0.03). 림프절 전이의 빈도를 포함한 다른 임상적, 병리적 특성들은 단일 조기위암과 비교하여 차이가 없었다. 24명 중 6명(25%)의 환자에서 27개의 부병변 중에서 6개(25%)의 동시성 병변을 수술 전에 발견하지 못하였다. 육안적으로 5개의 병변이 평탄형이었고, 1개의 병변이 함몰형이었다. 5개의 병변은 위의 하부와 중부의 전벽과 후벽에 위치하였고, 1개는 상부의 소만측에 위치하였다. 병변의 크기는 직경이 4 mm인 병변이 2개, 8 mm인 병변이 1개, 12 mm인 병변이 2개가 있었고, 15 mm인 것이 1개 있었고, 평균 직경은 9.1 mm이었다. 병리학적 소견은 4개가 분화형 암, 2개가 미분화형 암으로 모두 점막에 국한된 병변이었다. 결론 : 다발성 동시성 조기위암은 단일 조기위암과 비교하여 남성에서 호발하는 것 외에는 동일한 임상적, 병리적 소견을 보였다. 조기위암의 진료 시에는 다발성 병변의 가능성을 고려하여 주병변과 같거나 인접한 부위의 전벽 및 후벽과 소만부를 포함한 위 전체에 대한 세심한 검사가 필요하다.

Keywords

References

  1. Moertel CG, Bargen JA, Soule EH. Multiple gastric cancers: review of the literature and study of 42 cases. Gastroenterology 32:1095-1103, 1957
  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 189: 116-119, 2005 https://doi.org/10.1016/j.amjsurg.2004.03.013
  3. Kodera Y, Yamamura Y, Torii A, Uesaka K, Hirai T, Yasui K, Morimoto T, Kato T, Kito T. Incidence, diagnosis and significance of multiple cancer. Br J Surg 82:1540-1543, 1995 https://doi.org/10.1002/bjs.1800821127
  4. Morita M, Kuwano H, Baba H, Taketomi A, Kohnoe S, Tomoda H, Araki K, Saeki H, Kitamura K, Sugimach K. Multifocal occurrence of gastric carcinoma in patients with a family history of gastric carcinoma. Cancer 83:1307-1311, 1998 https://doi.org/10.1002/(SICI)1097-0142(19981001)83:7<1307::AID-CNCR6>3.0.CO;2-F
  5. Folli S, Dente M, Dell'Amore D, Gaudio M, Nanni O, Saragoni L, Vio A. Early gastric cancer: prognostic factors in 223 patients. Br J Surg 82:952-956, 1995. https://doi.org/10.1002/bjs.1800820732
  6. Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Gennari L. Subtotal versus total gastrectomy for gastric cancer. Ann Surg 230:170-178, 1999 https://doi.org/10.1097/00000658-199908000-00006
  7. Gouzi JL, Huguier M, Fagniez PL, Launois B, Flamant Y, Lacaine F, Paguet JC, Hay JM. Subtotal versus total gastrectomy for adenocarcinoma of the gastric antrum. Ann Surg 209:162-166, 1989 https://doi.org/10.1097/00000658-198902000-00005
  8. Furukawa H, Hiratsuka M, Ishiguro S. Study of multiple gastric cancer. Stomach Intestine 29:701-706, 1994
  9. Kumai K, Sakurai Y, Hoshiya Y, Yoshida M, Otani Y, Kubota T, Kitajima M. Treatment for multiple early gastric cancer. Jpn J Gastroenterol Surg 28:2087-2090, 1995 https://doi.org/10.5833/jjgs.28.2087
  10. Furukawa Y, Hiratsuka M, Iwanaga T, Imaoka S, Ishikawa O, Kabuto T, Sasaki Y, Kameyama M, Ohigashi H, Nakamori S, Nakano H, Yasuda T. A pathological type oriented surgical treatment for multifocal gastric cancer. Jpn J Gastroenterol Surg 28:2111-2114, 1995 https://doi.org/10.5833/jjgs.28.2111
  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 21:832-836, 1997 https://doi.org/10.1007/s002689900313
  12. Seto Y, Nagawa H, Muto T. Treatment of multiple early gastric cancer. Jpn J Clin Oncol 26:134-138, 1996 https://doi.org/10.1093/oxfordjournals.jjco.a023196
  13. Borie F, Plaisant N, Millat B, Hay J, Fagniez P, de Saxce B. Treatment and prognosis of early multiple gastric cancer. Eur J Surg Oncol 29:511-514, 2003 https://doi.org/10.1016/S0748-7983(03)00094-5
  14. Isozaki H, Tanaka N, Okajima K. General and specific prognostic factors of early gastric carcinoma treated with curative surgery. Hepatogastroenterology 46:1800-1808, 1999
  15. Newman E, Brennan MF, Hochwald SN, Harrison LE, Karpeh MS Jr. Gastric remnant carcinoma: just another proximal gastric cancer or a unique entity? Am J Surg 173:292-297, 1997 https://doi.org/10.1016/S0002-9610(96)00403-5
  16. Yoo CH, Noh SH, Shin DW, Choi SH, Min JS. Recurrence following curative resection for gastric carcinoma. Br J Surg 87:236-242, 2000 https://doi.org/10.1046/j.1365-2168.2000.01360.x
  17. Guadagni S, Catarci M, Kinoshita T, Valenti M, de Bernardinis G, Carboni M. Causes of death and recurrence after surgery for early gastric cancer. World J Surg 21:434-439, 1997. https://doi.org/10.1007/PL00012266
  18. Sasako M, Maruyama K, Kinosita T, Okabayashi K. Surgical treatment of carcinoma of the gastric stump. Br J Surg 78:822-824, 1991 https://doi.org/10.1002/bjs.1800780718
  19. Ikeguchi M, Kondou A, Shibata S, Yamashiro H, Tsujitani S, Maeta M, Kaibara N. Clinicopathological difference between carcinoma in the gastric remnant stump after distal partial gastrectomy for benign gastroduodenal lesions and primary carcinoma in the upper third of the stomach. Cancer 73:15-21, 1994 https://doi.org/10.1002/1097-0142(19940101)73:1<15::AID-CNCR2820730105>3.0.CO;2-J
  20. Pointner R, Schwab G, Konigsrainer A, Bodner E, Schmid KW. Early cancer of the gastric remnant. Gut 29:298-301, 1988. https://doi.org/10.1136/gut.29.3.298
  21. Fukutomi H, Sakita T. Analysis of early gastric cancer cases collected from major hospitals and institutes in Japan. Jpn J Clin Oncol 14:169-179, 1984
  22. Itoh H, Oohata Y, Nakamura K, Nagata T, Mibu R, Nakayama F. Complete ten-year postgastrectomy follow-up of early gastric cancer. Am J Surg 158:14-16, 1989 https://doi.org/10.1016/0002-9610(89)90305-X
  23. Habu H, Takeshita K, Sunagawa M, Endo M. Prognostic factors of early gastric cancer: results of long-term follow-up and analysis of recurrent cases. Jpn J Surg 17:248-255, 1987 https://doi.org/10.1007/BF02470696
  24. Kitaoka H, Yoshikawa K, Hirota T, Itabashi M. Surgical treatment of early gastric cancer. Jpn J Clin Oncol 14:283-293, 1984
  25. Abe S, Ogawa Y, Nagasue N, Sasaki Y, Akamizu H, Hirose S, Yukaya H, Suehiro S. Early gastric cancer: results in general hospital in Japan. World J Surg 8:308-314, 1984 https://doi.org/10.1007/BF01655060
  26. Farley DR, Donohue JH, Nagorney DM, Carpenter HA, Katzmann JA, Ilstrup DM. Early gastric cancer. Br J Surg 79:539-542, 1992 https://doi.org/10.1002/bjs.1800790621
  27. Guadagni S, Reed PI, Johnston BJ, de Bemardinis G, Catarci M, Valenti M, di Orio F, Carboni M. Early gastric cancer: follow-up after gastroectomy in 159 patients. Br J Surg 80:325-328, 1993 https://doi.org/10.1002/bjs.1800800319
  28. Namieno T, Koito K, Higashi T, Shimamura T, Yamashita K, Kondo Y. Tumor recurrence following resection for early gastric carcinoma and its implications for a policy of limited resection. World J Surg 22:869-873, 1998 https://doi.org/10.1007/s002689900484
  29. Mitsudomi T, Watanabe A, Matsusaka T, Fujinaga Y, Fuchigami T, Iwashita A. A clinicopathological study of synchronous multiple gastric cancer. Br J Surg 76:237-240, 1989 https://doi.org/10.1002/bjs.1800760308
  30. Huguier M, Ferro L, Barrier A. Early gastric carcinoma: spread and multicentricity. Gastric Cancer 5:125-129, 2002 https://doi.org/10.1007/s101200200022
  31. Miyoshi E, Haruma K, Hiyama T, Tanaka S, Yoshihara M, Shimamoto F, Chayama K. Micro-satellite instability is a genetic marker for the development of multiple gastric cancers. Int J Cancer 95:350-353, 2001 https://doi.org/10.1002/1097-0215(20011120)95:6<350::AID-IJC1061>3.0.CO;2-A
  32. Takahashi H, Endo T, Yamashita K, Arimura Y, Yamamoto H, Sasaki S, Itoh F, Hirata K, Imamura A, Kondo M, Sato T, Imai K. Mucin phenotype and microsatellite instability in early multiple gastric cancers. Int J Cancer 100:419-424, 2002 https://doi.org/10.1002/ijc.10501
  33. Yao T, Oya M, Utsunomiya H, Tsuneyoshi M, Iwashita A. Preoperatively missed lesions of multifocal early gastric cancer. Stomach Intestine 29:633-636, 1994
  34. Moreaux J, Bougaran J. Early gastric cancer: a 25-years surgical experience. Ann Surg 217:347-355, 1993 https://doi.org/10.1097/00000658-199304000-00006
  35. Pacelli F, Doglietto GB, Alfieri S, Carriero C, Malerba M, Crucitti PF, Caprino P, Crucitti F. Survival in early gastric cancer: multivariate analysis on 72 consecutive cases. Hepatogastroenterology 46:1223-1228, 1999
  36. Kasakura Y, Fujii M, Mochizuki F, Imai S, Kanamori N, Suzuki T. Clinicopathological features of the superficial spreading type of early gastric cancer. Gastric Cancer 2:129-135, 1999 https://doi.org/10.1007/s101200050035
  37. Sano T, Sasako M, Kinoshita T, Maruyama K. Recurrence of early gastric cancer: follow-up of 1475 patients and review of the Japanese literature. Cancer 72:3174-3178, 1993 https://doi.org/10.1002/1097-0142(19931201)72:11<3174::AID-CNCR2820721107>3.0.CO;2-H
  38. IARC Working Group. Schistosomes, liver flukes and Helicobacter pylori. IARC Monogr Eval Carcinog Risks Hum 61:1-241, 1994
  39. Kaminishi M. Diversity of gastric carcinogenesis. Oncology 69:1-8, 2005
  40. Yuasa Y. Control of gut differentiation and intestinal type gastric carcinogenesis. Nat Rev Cancer 3:592-600, 2003 https://doi.org/10.1038/nrc1141
  41. Nakashima H, Inoue H, Honda M, Shibuta K, Arinaga S, Mori M, Ueo H, Era S, Akiyoshi T. The heterogeneity of microsatellite instability in multiple gastric cancers. Am J Gastroenterol 90:653-656, 1995
  42. Kabashima A, Yao T, Sugimach K, Tsuneyoshi M. Gastric or intestinal phenotypic expression in the carcinomas and background mucosa of multiple early gastric carcinomas. Histopathology 37:513-522, 2000 https://doi.org/10.1046/j.1365-2559.2000.01008.x
  43. Tatsuta M, Iishi H, Okuda S, Taniguchi H. Diagnosis of early gastric cancer in the upper part of the stomach by the endoscopic Congo red-methylene blue test. Endoscopy 16:131-134, 1984 https://doi.org/10.1055/s-2007-1018556
  44. Iishi H, Tatsuta M, Okuda S. Diagnosis of simultaneous multiple gastric cancers by the endoscopic Congo red-methylene blue test. Endoscopy 20:78-82, 1988 https://doi.org/10.1055/s-2007-1018137
  45. Dinis-Ribeiro M. Chromoendoscopy for early diagnosis of gastric cancer. Eur J Gastroenterol Hepatol 18:831-838, 2006 https://doi.org/10.1097/00042737-200608000-00005
  46. Song WK, Wilson BC. Endoscopic detection of early upper GI cancers. Best Pract Res Clin Gastroenterol 19:833-856, 2005 https://doi.org/10.1016/j.bpg.2005.04.006