PROBLEMS OF MULTIPLE LESIONS IN THE TREATMENT OF GASTRIC CANCER

Multiple gastric cancer has been found out in 45 (9.0%) cases among 502 cases of primary gastric cancer treated at the department, and are characterized by the following features: 1. Those patients were older than patients with solitary lesion when they were operated on; macroscopically those main lesions were predominantly elevated type in the superficial type, or type 1 or 2 in the advanced type; and commonly had tumors with invasion depth of t1 and histologically well differentiated type. 2. In multiple cases, an averaged distance between the main and other lesions was 4.2±2.8cm, and longer distance 6.0cm or more was seen in 20% of cases. 3. When the main lesions were early gastric cancer, macroscopic type of the other lesions resembled that of the main lesion. Histological types of other lesions were mostly differentiated type irrespective of that of the main lesion, but the histologic types became different when the distance between tumors was longer. 4. Lesions other than the main lesion which were overlooked preoperatively were often smaller in diameter than those of correctly diagnosed lesions, and were predominantly cancers with the invasion depth of m, but there was no significant difference in the distance between lesions. In the preoperative investigation and postoperative follow-up of such patients, careful observation entertaining the above features would be necessary.