Original article
Clinical endoscopy
Lymph node metastasis in multiple synchronous early gastric cancer

https://doi.org/10.1016/j.gie.2011.04.009Get rights and content

Background

Although endoscopic resection for early gastric cancer (EGC) is increasingly available, it has not been determined whether indications for endoscopic resection are equally acceptable for multiple EGCs.

Objective

To compare the various clinicopathologic factors and risk of lymph node (LN) metastasis between multiple and solitary EGCs.

Design

Case-control study.

Setting

University hospital.

Patients

This study involved 1717 patients with 156 multiple and 1561 solitary EGCs.

Intervention

Gastrectomy with LN dissection.

Main Outcome Measurements

Incidence of LN metastasis.

Results

In multiple EGCs, main lesions had larger tumor size and deeper invasion depth than the accessory lesions (P < .001). The clinicopathologic features of multiple EGCs were similar to those of solitary EGCs with respect to tumor size, depth of invasion, lymphovascular invasion, and incidence of LN metastasis. Importantly, the risk of LN metastasis in multiple EGCs that met the indication criteria for endoscopic resection was not significantly different from that in solitary EGCs. Tumors meeting conventional indications for endoscopic resection had no risk of LN metastasis, whereas tumors meeting expanded indications showed a similar risk of LN metastasis in the two groups. In multiple EGCs, tumor size ≥3 cm and lymphovascular invasion were independent risk factors of LN metastasis.

Limitations

Small number of patients with multiple EGCs studied.

Conclusion

Multiple EGCs had clinicopathologic characteristics and risk of LN metastasis similar to those of solitary EGCs. Endoscopic resection may be adopted as curative treatment for multiple EGCs that meet indications for endoscopic resection. Further studies are needed to verify the present study results.

Section snippets

Patients and treatment

From August 2005 to December 2009, cases of patients with EGC who were enrolled at Seoul National University Hospital were reviewed. From the electronic medical records, a total of 2240 patients with pathologically confirmed EGC were eligible for the study. All patients underwent curative treatment by surgery or endoscopic resection, depending on the conventional indications for endoscopic resection,3 the results of pretreatment staging (abdominal multiple-detector row CT, and/or EUS),

Clinicopathologic characteristics

A total of 1717 patients (156 in the multiple EGC group and 1561 in the solitary EGC group) were included in the study. Among the patients with multiple EGCs, partial gastrectomy was performed in 115 (73.7%), and total gastrectomy was performed in 41 (26.3%). A total of 343 lesions in 156 patients with multiple EGCs were detected: 2 lesions (n = 135), 3 (n = 16), 4 (n = 3), and >5 lesions (n = 2). Compared with solitary EGCs, multiple EGCs occurred in older patients and were more common in men.

Discussion

Although the indications for endoscopic resection in EGC have progressively expanded, the specific indication criteria for multiple EGCs have not been determined. The results of the present study suggest that the clinicopathologic features of multiple EGCs were not significantly different from those of solitary EGCs, with the same risk of LN metastasis between groups.

The incidence of multiple synchronous EGC was 7.7% (173/2240 patients) in our study, which was in agreement with a previous

References (21)

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    2020, Clinics and Research in Hepatology and Gastroenterology
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    With regard to the number of lesions, two are generally found and more than three lesions are not common. These findings are in accordance with those of previous reports [5,6,8]. On the other hand, several studies revealed that synchronous multiple early gastric cancer more frequently involved the upper third of the stomach compared with solitary lesions [7,9].

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    Other non-Asian countries have reported varying rates, from <3% in Brazil among those meeting expanded criteria to 13.3% in Germany [15,20]. In Asian countries, positive lymph node status among tumors meeting expanded criteria is far lower, almost uniformly <3% [7,21,22]. One possible reason for the difference may be location of the tumor.

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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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