Synchronous Gastric Cancer Research Articles

縦隔鏡補助下に切除した食道癌と十二指腸球部嵌頓胃癌の重複表在癌の1例

縦隔鏡補助下に切除した食道癌と十二指腸球部嵌頓胃癌の重複表在癌の1例

A study of metachronous cancer after endoscopic resection of early gastric cancer

Objective. Endoscopic resection is commonly used for early gastric cancer (EGC) in Korea and Japan. There are only a few reports of metachronous cancer after endoscopic resection. The aim of this study was to identify clinical factors associated with metachronous gastric cancer after endoscopic resection. Methods. A total of 176 patients with EGC who had underwent endoscopic submucosal dissection (ESD) were periodically followed-up with endoscopic examinations from January 2004 to December 2007. The incidence and variable factors of metachronous gastric cancer were investigated in a retrospective study. Results. The median interval between the diagnosis of primary cancer and the diagnosis of the first metachronous cancer was 30 months (range 18–42 months). Metachronous gastric cancer had developed in nine patients (5.1%) during follow-up period and seven patients (4.0%) had synchronous gastric cancer lesions within 1 year of the initial endoscopic treatment. Annual incidence rate of metachronous cancer was approximately 3.3%. Antrum atrophy and old age were significantly associated with the incidence of metachronous cancer. The status of Helicobacter pylori, size, location and gross finding of lesion had no significant relationship with metachronous occurrence. Conclusions. We should examine more carefully older patients who have atrophic gastritis because secondary cancer including metachronous cancer might occur in remnant stomach after initial successful endoscopic resection. And prospective study will be needed for the optimal endoscopic surveillance interval.

The Synchronous Prevalence of Colorectal Neoplasms in Patients with Stomach Cancer

See Article on Page 246-251 Stomach cancer is still the most common malignancy in Korea in spite of its dramatically decreasing tendency during the last two decades. More importantly, the incidence of colorectal cancer has been increasing during the same period, so clinicians frequently experience synchronous or metachronous stomach cancer with colorectal cancer. Several reports on colorectal cancer with stomach cancer have been published in Asian countries. In 2010, Yoon et al. [1] reported clinicopathologic data for colorectal cancer with synchronous and metachronous stomach cancer. They reviewed 8,680 patients who underwent surgery for primary sporadic colorectal cancer from 1989 to 2008. They revealed that the incidences of synchronous and metachronous gastric cancer were 0.93 and 1.4%, respectively (combined 2.4%). The standardized incidence ratio was 1.199 (95% confidence interval, 1.005 to 1.420). This result is slightly lower than the data for Japan [2] published in 1999. However, Eom et al. [3] reported that the incidence of synchronous or metachronous cancer with gastric cancer was 3.4% based on data for 4,593 patients who underwent gastric cancer surgery. The most common other primary cancer was colorectal cancer (20.1%), followed by lung cancer and liver cancer. Actually, this result is little different from the results published in other papers. Wu et al. [4] analyzed 99 multiple primary cancers with gastric cancer in Taiwan. In the 77 male patients, prostate cancer was the most common (19.5%), followed by cancers of the colon (18.2%) and liver (14.3%). In the 22 female patients, colon cancer was the most common (31.9%), followed by breast and cervix cancers (22.7%). Such data revealed the importance of colorectal cancer screening because colorectal cancer is second common cancer occurring with stomach cancer. In Korea, Lim et al. [5] reported a prospective study that analyzed the esophagogastroduodenoscopy results from 1,542 consecutive colorectal cancer patients. In their series, synchronous gastric cancers were detected in 31 cases (2.0%). Of these 31 cases, 26 had early gastric cancer (EGC, 83.9%) and 5 had advanced gastric cancer. Ten (38.5%) of the 26 EGC cases were managed using an endoscopic mucosal resection. Compared to colorectal cancer patients without synchronous gastric cancer, the group of patients with synchronous gastric cancer was older (65.5+/-9.6 vs. 58.4+/-11.3 years, P = 0.001) and had a greater proportion of males (77.4 vs. 59.4%, P = 0.043). In this research from July 2005 to June 2010, the authors included a total of 123 patients with stomach cancer (86 male), and 246 consecutive, age- and sex-matched persons without stomach cancer were analyzed. All of them underwent a colonoscopy within 6 months after undergoing a gastroscopy. The prevalence of colorectal neoplasms was significantly higher in the stomach cancer group (35.8%) than in the control group (17.9%, P < 0.001). This paper reports on a kind of case-control study, but still had a weak point of no randomization and retrospective analysis. Also, the authors analyzed all kinds of neoplasms in the colon, including tubular adenomas, villous adenomas and adenocarcinomas. The incidences of pure adenocarcinomas were 6.8% and 0% in the stomach cancer group and the normal control group, respectively. Another weak point is the small size of materials compared to other reports. We have to be cautious in accepting the statistical results reported in this paper. The biology of stomach cancer is apparently different from that of colorectal cancer, as are the risk factors for occurrence and the incidence of relapse. A larger-scale epideiologic study would be essential before concluding that the incidence of colorectal cancer in patients with stomach cancer is higher than it is in the general population.

Clinicopathologic Characteristics of Colorectal Cancer Patients with Synchronous and Metachronous Gastric Cancer

Clinicopathologic Characteristics of Colorectal Cancer Patients with Synchronous and Metachronous Gastric Cancer

Simultaneous Laparoscopy-assisted Distal Gastrectomy and Right Hemicolectomy for Synchronous Advanced Gastric and Colon Cancer

Concurrent laparoscopic surgery for the synchronous gastric and colon cancer in one patient is not only a rare procedure, but also has some demerits such as longer operation time, more blood loss, and the use of additional laparoscopic ports. Moreover, laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection is still controversial in the case of advanced gastric cancer. We report the successful laparoscopic surgery of a 78-year-old patient with synchronous advanced gastric and right colon cancers. The laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection followed by right hemicolectomy through 7 ports was carried out. All procedures were successfully performed without complications and the patient has had no evidence of recurrence for 33 months after the operation. Synchronous neoplasms that are distantly located from one another could be treated using minimally invasive technique, which may sufficiently relieve patients' postoperative distress in selected cases.

Clinicopathologic Characteristics of Colorectal Cancer Patients with Synchronous and Metachronous Gastric Cancer

We investigated the characteristics of synchronous and metachronous gastric cancer in patients with colorectal cancer. We reviewed 8,680 patients who underwent operations for primary sporadic colorectal cancer from 1989 to 2008. Synchronous gastric cancer was defined as gastric cancer diagnosed within 6 months of a colorectal cancer diagnosis. Gastric cancer diagnosed more than 6 months before or after colorectal cancer was defined as metachronous. The incidences of synchronous and metachronous gastric cancer were 0.93 and 1.4%, respectively (combined 2.4%). The standardized incidence ratio was 1.199 (95% confidence interval [CI] = 1.005-1.420) when the patients with premetachronous gastric cancer were excluded. Patients with synchronous and metachronous gastric cancer were 5 years older on average compared to the control population without gastric cancer. In addition, multivariate analysis revealed an odds ratio (OR) of 3.6 for being male, OR = 2 for positive family history of solid tumors, OR = 2.2 for colonic lesion, and OR = 4 for MSH2 expression loss compared to patients without gastric cancer. Patients with postmetachronous gastric cancer (when compared to synchronous and premetachronous gastric cancer), a preoperative CEA level of less than 6 ng/ml, and a relatively early stage of colorectal cancer had significantly higher overall (p = 0.016, 0.007, and 0.004, respectively) and disease-free survival rates (p = 0.046, 0.003, and 0.004, respectively), only on univariate analysis. Lymphovascular invasion of colorectal cancer and an advanced stage of gastric cancer were independent poor prognostic factors for both overall (p = 0.018) and disease-free survival (p = 0.028). Gastric cancer surveillance is recommended for patients with colorectal cancer, especially when the patient is old and male, has a positive family history of solid tumors, has a colonic lesion, or lacks MSH2 expression.

Superdrainage of the ileocolic vein to the internal jugular vein interposed by an inferior mesenteric vein graft in replacing the esophagus with the right hemicolon

The fear of serious complications, such as a necrotic conduit caused by an impaired blood circulation can arise when replacing the esophagus with an intestinal conduit. The aim of this paper is to present effective superdrainage of an intestinal conduit using an inferior mesenteric vein (IMV) interposition graft. In 2008, we performed superdrainage of the ileocolic vein to the internal jugular vein interposed by an IMV graft in replacing the esophagus with the right hemicolon for advanced thoracic esophageal cancer in three patients with a synchronous gastric cancer or a previous gastrectomy. No leakage at the enteric anastomoses occurred. Neither ischemic lesions in these intestinal conduits nor complications caused by harvesting an IMV graft were observed. Superdrainage of the ileocolic vein to the internal jugular vein interposed by an IMV graft effectively improves the blood circulation in intestinal conduits brought up to the neck as an esophageal replacement.

Microsatellite Instability Is Associated with the Clinicopathologic Features of Gastric Cancer in Sporadic Gastric Cancer Patients

PurposeReplication error is an important mechanism in carcinogenesis. The microsatellite instability (MSI-H) of colorectal cancers is associated with the development of multiple cancers. The influence of MSI-H on the development of multiple gastric cancers in sporadic gastric cancer patients has not been defined. This study was performed to reveal the association between the clinicopathologic features and MSI in sporadic gastric cancers.Materials and MethodsBetween July 2004 and March 2009, the clinicopathologic characteristics, including MSI status, were evaluated in 128 consecutive patients with sporadic gastric cancers. None of the patients had hereditary non-polyposis colorectal cancer of familial gastric cancer. The markers that were recommended by the NCI to determine the MSI status for colorectal cancers were used.ResultsMSI-H cancers were found in 10.9% of the patients (14/128). Synchronous gastric cancers were shown in 4 patients (3.1%). Synchronous cancers were found in 2 of 14 patients with MSI-H gastric cancer (14.3%) and 2 of 114 patients with MSS gastric cancer (1.8%; P=0.059, Fisher's exact test). Among the patients with synchronous cancer 50% (2/4) had MSI-H cancer, but 9.7% of the patients (12/124) without synchronous cancer had MSI-H cancer. MSI-H (RR, 24.7; 95% CI, 1.5~398.9; P=0.024) was related with to synchronous gastric cancer, but age, gender, family history, histologic type, location, gross morphology, size, and stage were not related to synchronous gastric cancer.ConclusionsMSI is associated with the intestinal-type gastric cancer and the presence of multiple gastric cancers in patients with sporadic gastric cancer. Special attention to the presence of synchronous and the development of metachronous multiple cancer in patients with MSI-H gastric cancer is needed.

Clinicopathologic Features of Metachronous or Synchronous Gastric Cancer Patients with Three or More Primary Sites

PurposeWe investigated the clinicopathologic information of patients with gastric cancer with multiple primary cancers (GC-MPC) of three or more sites.Materials and MethodsBetween 1995 and 2009, 105,908 patients were diagnosed with malignancy at Severance Hospital, Yonsei University Health System. Of these, 113 (0.1%) patients with MPC of three or more sites were registered, and 41 (36.3%) of these were GC-MPC. We retrospectively reviewed the clinical data and overall survival using the medical records of these 41 GC-MPC patients. We defined synchronous cancers as those occurring within 6 months of the first primary cancer, while metachronous cancers were defined as those occurring more than 6 months later.ResultsPatients with metachronous GC-MPC were more likely to be female (p=0.003) and young than patients with synchronous GC-MPC (p=0.013). The most common cancer sites for metachronous GC-MPC patients were the colorectum, thyroid, lung, kidney and breast, while those for synchronous GC-MPC were the head and neck, esophagus, lung, and kidney. Metachronous GC-MPC demonstrated significantly better overall survival than synchronous GC-MPC, with median overall survival durations of 4.7 and 14.8 years, respectively, and 10-year overall survival rates of 48.2% and 80.7%, respectively (p<0.001).ConclusionMultiplicity of primary malignancies itself does not seem to indicate a poor prognosis. The early detection of additional primary malignancies will enable proper management with curative intent.

Patients With Lung Cancer With Metachronous or Synchronous Gastric Cancer

Background There are few reports of treatment and outcome for patients with metachronous or synchronous lung and gastric cancers. To evaluate them, we conducted a retrospective study. Patients and Methods The medical records of patients with lung cancer who previously or simultaneously had gastric cancer seen in our division between January 1979 and July 2008 were reviewed. Results Forty-five (3.2%) of 1391 patients had previous or simultaneous gastric cancer. The proportion of men was higher among patients with lung cancer with gastric cancer than those without ( P = .0006). There was a significant difference in age at the time of diagnosis of lung cancer between the 45 patients with gastric cancer and the 1346 patients without it ( P = .0344). The proportion of smokers was higher among lung cancer patients with gastric cancer than those without ( P = .0015). Twenty-seven of 45 patients had smoking-related cell types of lung cancer: squamous cell carcinoma and small-cell lung cancer. The proportion of these 2 cell types was higher in patients with lung cancer with gastric cancer than those without ( P = .02). The diagnosis of gastric cancer preceded the diagnosis of lung cancer in 33 patients, and the median duration from the diagnosis of gastric cancer to that of the lung cancer was 6 years. Conclusion For patients with gastric cancer, smoking cessation, a chest radiograph at least yearly for several years, and swift evaluation of signs or symptoms that are suggestive of lung cancer should be recommended, especially in elderly men with gastric cancer and smoking habit.

Laparoscopic surgery for synchronous gastric and colorectal cancer: a preliminary experience

Increasingly, laparoscopy-assisted gastrectomy and laparoscopy-assisted colorectal surgery are being performed. However, simultaneous laparoscopic surgery for synchronous gastric and colorectal cancer is rare and its feasibility unknown. Early surgical outcomes, including operation time, intraoperative bleeding, postoperative morbidity, mortality, and the duration of the postoperative hospital stay, were investigated in seven consecutive patients who underwent simultaneous laparoscopy-assisted gastrectomy and colorectal surgery at the Cancer Institute Hospital between 2005 and 2008 to clarify the feasibility of simultaneous laparoscopic surgery. Mean operation time was 392 min and estimated blood loss was 90 mg in patients undergoing simultaneous laparoscopic surgery. Although postoperative morbidity was observed in three patients (surgical site infection, gastric fullness, and enteritis), they recovered well, and the duration of postoperative hospital stay was 19.6 +/- 14.1 days. There was no postoperative mortality. Intraoperative complication which required conversion to open surgery was also not found in any of the patients. A small incision measuring 5-6 cm in length was sufficient for both retrieval of resected specimen and enteric anastomosis in all patients. The laparoscopic approach is a feasible procedure for synchronous gastric and colorectal cancer, provided that the operation is performed by experienced surgeons.

Laparoscopy-assisted combined resection for synchronous gastric and colorectal cancer: Report of three cases

In gastric cancer patients, the most common form of synchronous cancer is colorectal cancer. To reduce the invasiveness of the resection, a laparoscopy-assisted combined resection was performed in three patients with synchronous gastric and colorectal cancer. Although all gastric lesions were in the early stages, two colorectal lesions were advanced cases. In all cases, the laparoscopic gastric resection and reconstruction was performed first, followed by the colorectal resection. In the case of right-side colon cancer in addition to gastric cancer, it was relatively easy to perform the combined resection with lymph node dissection sharing the same ports used for the gastrectomy, although we needed an additional port. In one case, in which rectal cancer was present in addition to gastric cancer located in the upper portion of the stomach, a totally laparoscopic proximal gastrectomy was combined with a laparoscopy-assisted low anterior resection, leaving only a lower abdominal minilaparotomy wound. All patients quickly returned to normal activity without remarkable complications, with the exception of a wound infection in one patient. With a mean follow-up of 30.7 months, all patients survived without any sign of recurrence. This procedure represents a feasible option for minimally invasive treatment of synchronous gastric and colorectal cancer.

Twenty-two metachronous multiple signet-ring cell carcinomas treated with repeated gastrectomies and repeated endoscopic mucosal resections: Report of a case

A 45-year-old Japanese woman underwent an endoscopic mucosal resection (EMR) for early gastric cancer at the Cancer Institute Hospital in July 1996. The patient then underwent a distal gastrectomy in 2002 because of a new early gastric cancer and repeated EMR for a total of six early gastric cancers in 2007. Finally, a total gastrectomy was performed in February 2008. The pathological examination of the resected specimen indicated 14 synchronous multiple early gastric cancers. Although the incidence of multiple gastric cancers has been reported to range from 5% to 15%, there is usually only a double or triple lesion. Moreover, multiple gastric cancer is typically observed in male elderly patients as differentiated adenocarcinomas. The present case was a young female patient and all of the lesions were intramucosal signet-ring cell adenocarcinomas. The carcinogenetic mechanism in this case may therefore be different from that in typical multiple gastric cancers. A thorough preoperative examination and regular postoperative follow-up are therefore essential for detecting multiple gastric cancers in their early stages.

Synchronous early gastric cancer and gastrointestinal stromal tumor in the stomach of a patient with idiopathic thrombocytopenic purpura

The synchronous occurrence of gastrointestinal stromal tumour (GIST) in the stomach and early gastric cancer is uncommon, with only a few previous reports. In particular, the collision of GIST and early gastric cancer in a patient with idiopathic thrombocytopenic purpura (ITP) has never been reported. We present the case of a 78-year-old male patient with ITP who was diagnosed with a synchronous development of GIST and early gastric cancer of the stomach. He underwent an elective subtotal gastrectomy with splenectomy. We discuss whether the development of GIST in the stomach in concert with early gastric cancer is an incidental coexistence or involve the same carcinogenic agents. Furthermore, it is not known whether or not such a situation is connected with ITP. To our knowledge this is the second report of a small GIST concomitant with an early gastric cancer and the first one in a patient with ITP.

Synchronous esophageal and gastric cancer complicated by a duplicated benign tumor in the stomach: one-case analysis

Synchronous esophageal and gastric cancer complicated by a duplicated benign tumor in the stomach: one-case analysis

Pseudomesotheliomatous adenocarcinoma of the lung with synchronous gastric and esophageal cancer

Pseudomesotheliomatous adenocarcinoma is an uncommon variant of peripheral lung cancer. This condition mimics a malignant mesothelioma in terms of its clinical presentation and its gross and microscopic appearance. An immunohistochemical investigation is important when it is difficult to determine whether diffuse carcinomatous involvement of the pleura is secondary to metastasis, lung cancer, or mesothelioma. We herein report a very rare case of concomitant pseudomesotheliomatous adenocarcinoma, gastric cancer and esophageal cancer.

Synchronous gastric cancer in primary sporadic colorectal cancer patients in Korea

Colorectal cancer has been reported to be the malignancy most frequently associated with gastric cancer in Korea. The aim of this study was to define the frequency and clinical characteristics of synchronous gastric cancer detected at preoperative esophagogastroduodenoscopy (EGD) in colorectal cancer patients. This prospective study analyzed the EGD results from 1,542 consecutive colorectal cancer patients who underwent surgery from January 2003 to December 2005 at the Center for Colorectal Cancer, National Cancer Center, Korea. Of the 1,542 cases, 1,155 (74.9%) underwent EGD at our center and 387 underwent EGD at other hospitals within 6 months before surgery. Of the 1,542 cases, synchronous gastric cancers were detected in 31 cases (2.0%). Of these 31 cases, 26 had early gastric cancer (EGC; 83.9%) and 5 had advanced gastric cancer. Ten (38.5%) of the 26 EGC cases were managed using endoscopic mucosal resection. Compared to colorectal cancer patients without synchronous gastric cancer, the group of patients with synchronous gastric cancer was older (65.5+/-9.6 vs 58.4+/-11.3 years, p=0.001) and had a greater proportion of males (77.4 vs 59.4%, p=0.043). This study found that 2% of Korean sporadic colorectal cancer patients had synchronous gastric cancer. A preoperative EGD for colorectal cancer patients is likely to greatly assist in the diagnosis of synchronous gastric cancer at an early stage and the implementation of appropriate minimally invasive treatment.

Clinical analysis of 13 cases of synchronous gastric and colorectal cancer

Objective To investigate the clinical characteristics and prognosis of patients with synchronous gastric and colorectal cancer.

Allelic loss of 14q32 in the pathogenesis of gastrointestinal and ampullary malignancies: mapping of the target region to a 17�cM interval

The genetic basis for gastrointestinal and ampullary carcinomas remains uncertain. This study was performed to pinpoint novel chromosomal region involved in the tumorigenesis of gastrointestinal tract. We screened the allelic status on 16 chromosomal arms in a patient with synchronous ampullary carcinoma and gastric cancer, but who had no family history of familial cancer syndrome. The significance of the shared 14q deletion was examined on clinical cohorts of sporadic gastric (n=12) and ampullary (n=10) carcinoma, respectively. Then, high-density allelotype mapping was performed on 14q32 by using 23 microsatellite markers for the synchronous tumors. The synchronous gastric and ampullary carcinomas had no frameshift mutations in the APC, MSH2, MSH3, and MSH6 genes. Among the microsatellite markers screened, only D14S267 showed identical loss in the synchronous tumors. The same allelic loss was also detected in one of ampullary carcinomas (10%) and two of gastric cancers (16.7%). Fine mapping of 14q determined a minimally deleted region between D14S65 and D14S1010 (17 centiMorgans) for the synchronous tumors. This study illustrates a paradigm using molecular genetic approach in identifying chromosome 14q32 that may harbor a tumor suppressor gene involved in the pathogenesis of a subset of gastrointestinal and ampullary malignancies.

腫瘍径70mmの高分化型肝細胞癌に, 同時性胃癌, 異時性大腸癌を伴った3重複癌の1例

腫瘍径70mmの高分化型肝細胞癌に, 同時性胃癌, 異時性大腸癌を伴った3重複癌の1例