Metachronous gastric cancers after endoscopic resection: how effective is annual endoscopic surveillance?
Endoscopic resection (ER) has been widely accepted in Japan as a less invasive treatment for early gastric cancer, but the incidence of subsequent metachronous gastric cancer (MGC) and the appropriate endoscopic follow-up interval after ER have not been determined as yet. In this study, we investigated the incidence of MGC after ER and assessed our annual endoscopic surveillance program after ER.
We studied the clinicopathological features of 633 consecutive ER patients (575 with a single lesion and 58 with synchronous multiple lesions) treated at our institution from 1987 through 2002, after excluding 158 patients who underwent additional surgery due to noncurative ERs, 180 patients whose surveillance periods were less than 1 year, 1 patient with hereditary non-polyposis colorectal cancer, and 1 patient with gastric tube cancer. We defined a second cancer found within 1 year after ER as “synchronous” and a second cancer found after 1 year as “metachronous.”
First MGCs had an overall incidence of 8.2% (52 out of 633 patients); the annual incidence was constant, and the cumulative 3-year incidence was 5.9%. The average time to the discovery of a first MGC after the initial ER was 3.1 ± 1.7 years (range, 1–8.6 years). Almost all first MGCs (96.2%, 50 out of 52 lesions) were treated curatively with repeat ER.
In order to detect MGC at a stage early enough for a curative repeat ER, an annual endoscopic surveillance program is both practical and effective for post-ER patients.
Moertel, CG, Bargen, JA, Soule, EH 1957Multiple gastric cancers; review of the literature and study of 42 casesGastroenterology321095103PubMed
Kosaka, T, Miwa, K, Yonemura, Y, Urade, M, Ishida, T, Takegawa, S, et al. 1990A clinicopathologic study on multiple gastric cancers with special reference to distal gastrectomyCancer6526025PubMed
Esaki, Y, Hirokawa, K, Yamashiro, M 1987Multiple gastric cancers in the aged with special reference to intramucosal cancersCancer595605PubMed
Kodera, Y, Yamamura, Y, Torii, A, Uesaka, K, Hirai, T, Yasui, K, et al. 1995Incidence, diagnosis and significance of multiple gastric cancerBr J Surg8215403PubMed
Iwafuchi, M, Watanabe, H 1996Synchronous multiple early gastric cancer; study of surgically resected stomach (in Japanese)Nippon Rinsho (Jpn J Clin Med)54121723
Mitsudomi, T, Watanabe, A, Matsusaka, T, Fujinaga, Y, Fuchigami, T, Iwashita, A 1989A clinicopathological study of synchronous multiple gastric cancerBr J Surg7623740PubMed
Honmyo, U, Misumi, A, Murakami, A, Haga, Y, Akagi, M 1989Clinicopathological analysis of synchronous multiple gastric carcinomaEur J Surg Oncol1531621PubMed
Takeda, J, Toyonaga, A, Koufuji, K, Kodama, I, Aoyagi, K, Yano, S, et al. 1998Early gastric cancer in the remnant stomachHepatogastroenterology45190711PubMed
Eguchi, T, Gotoda, T, Ichiro, O, Hamanaka, H, Noriaki, H, Saito, D 2003Is endoscopic one-piece mucosal resection essential for early gastric cancer?Dig Endosc151136CrossRef
Oda, I, Gotoda, T, Hamanaka, H 2005Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complications from a large consecutive seriesDig Endosc17548CrossRef
Kajitani, T 1981The general rules for the gastric cancer study in surgery and pathology. Part I. Clinical classificationJpn J Surg1112739PubMed
The general rules for the gastric cancer study in surgery and pathology. Part II. Histological classification of gastric cancer. Jpn J Surg 1981;11:140–5
Waki, T, Tamura, G, Tsuchiya, T, Sato, K, Nishizuka, S, Motoyama, T 2002Promoter methylation status of E-cadherin, hMLH1, and p16 genes in nonneoplastic gastric epitheliaAm J Pathol161399403PubMed
- Metachronous gastric cancers after endoscopic resection: how effective is annual endoscopic surveillance?
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