Early gastric carcinoma: spread and multicentricity |
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Authors: | Michel Huguier Leonardo Ferro Alain Barrier |
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Institution: | Department of Digestive Surgery, H?pital Tenon, Paris VI University, 4 rue de la Chine, 75020 Paris, France, FR
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Abstract: | Background: In early gastric carcinoma (EGC), after subtotal gastrectomy, recurrent lesions limited to the gastric remnant are the cause
of about 20% of deaths from recurrence. Therefore, it has been suggested to perform total gastrectomy in all cases of EGC.
Methods: We studied a case series of 82 consecutive patients operated on for an EGC, with a mean follow-up time of 72 months (range,
1–120 months). Subtotal distal gastrectomy was performed 61 patients, total gastrectomy in 15, and other procedures in 6.
Outcome measures were recurrence and causes of mortality, focusing on patients with resection line involvement and multifocal
lesions.
Results: EGC was limited to the mucosa in 43 patients and had invaded the submucosa in 39. Ten patients had a lymph node involvement.
In 4 patients having had a subtotal gastrectomy, resection line involvement was detected. In 3 patients, the involvement was
detected peroperatively on frozen sections, and a re-resection was performed. In the fourth patient, the involvement was detected
postoperatively, but follow-up endoscopies failed to show any residual tumor. In 17 patients, multifocal lesions were observed.
No recurrence was observed in the gastric remnant of patients having undergone a subtotal gastrectomy.
Conclusion: In distal EGC, a subtotal gastrectomy may be performed under two conditions: (1) careful endoscopic and peroperative examination
of the upper part of the stomach to detect multifocal lesions and (2) a systematic frozen-section assessment of the resection
margin to avoid inadequate resection.
Received: November 12, 2001 / Accepted: February 3, 2002
Offprint requests to: M. Huguier |
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Keywords: | Gastric carcinoma Surgery |
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