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Koseki Y, Hikage M, Terashima M, Notsu A, Furukawa K, Fujiya K, Tanizawa Y, Takada K, Imai K, Shiomi A, Bando E. The Effectiveness of Screening Total Colonoscopy for Preoperative Patients with Gastric Cancer. Ann Surg Oncol 2024; 31:762-771. [PMID: 37925659 DOI: 10.1245/s10434-023-14538-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the most common cancer that coincides with gastric cancer (GC). Although the usefulness of total colonoscopy (TCS) as a CRC screening tool has been reported in preoperative patients with GC, the long-term outcome of patients with synchronous CRC (SCRC) remains unclear. This study aims to clarify the significance of preoperative screening TCS for GC in terms of survival outcomes. PATIENTS AND METHODS We included 796 patients who underwent preoperative screening TCS for GC. The risk factors, clinicopathological features, and survival outcome of SCRC were examined. Furthermore, the cost-effectiveness was evaluated from the perspective of improving the rates of mortality caused by CRC. RESULTS SCRC was observed in 43 patients (5.4%). Endoscopic treatment for SCRC was performed on 30 patients. In total, 15 patients underwent surgical resection, including 2 patients requiring additional surgery after endoscopic treatment. Regarding pathological stages, 25 patients had stage 0, 12 patients had stage I, 5 patients had stage II, and 1 patient had stage IIIB disease. The cumulative mortality rates were as follows: GC-related deaths, 12.6%; deaths from cancers other than CRC, 1%; deaths from other causes, 5.5%. No deaths were attributed to SCRC. Comparing the patients who did not undergo TCS, an incremental cost-effectiveness ratio analysis suggested that a screening cost of 5.86 million yen was required to prevent one CRC death. CONCLUSIONS Curative treatment was possible in all patients with SCRC. No deaths were attributed to SCRC, suggesting that screening TCS for GC is effective.
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Affiliation(s)
- Yusuke Koseki
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Makoto Hikage
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
- Division of Surgery, Iwate Prefectural Isawa Hospital, Oshu, Japan
| | | | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Keiichi Fujiya
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kazunori Takada
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akio Shiomi
- Division of Colorectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
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Koseki Y, Hikage M, Terashima M, Notsu A, Furukawa K, Fujiya K, Tanizawa Y, Takada K, Imai K, Shiomi A, Bando E. ASO Author Reflections: Significance of Colorectal Cancer Screening Through Preoperative Total Colonoscopy for Gastric Cancer. Ann Surg Oncol 2024; 31:810-811. [PMID: 38044349 DOI: 10.1245/s10434-023-14641-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Yusuke Koseki
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Makoto Hikage
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
- Division of Surgery, Iwate Prefectural Isawa Hospital, Oshu, Japan
| | | | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Keiichi Fujiya
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kazunori Takada
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akio Shiomi
- Division of Colorectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
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Shima T, Arita A, Sugimoto S, Takayama S, Kawaguchi N, Imai Y, Kitahara T, Maeda T, Okuda J. Simultaneous colonic metastasis of advanced gastric cancer: a case report. Surg Case Rep 2023; 9:39. [PMID: 36930379 PMCID: PMC10023818 DOI: 10.1186/s40792-023-01622-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Although distant metastasis in gastric cancer can be present at the time of the initial diagnosis, colonic metastasis is extremely rare. This report describes a case of simultaneous colonic metastasis of advanced gastric cancer. CASE PRESENTATION The patient was a 78-year-old woman with nausea and epigastric pain. Upper gastrointestinal endoscopy revealed an advanced invasive ulcerative tumor in the lesser curvature of the stomach extending from the anterior to the middle portion. Colonoscopy revealed a 4-mm polyp-like lesion in the mid-transverse colon; therefore, a polypectomy was performed. Both gastric and colonic tumors showed poorly differentiated adenocarcinoma with signet ring cell carcinoma. After providing informed consent, the patient underwent a total gastrectomy. Histologic examination showed similar morphologic features of both gastric and colonic tumors. Immunohistochemistry staining showed that these tumor cells were positive for cytokeratin (CK) 7 and negative for CK20. CONCLUSIONS This was an extremely rare case of simultaneous colonic metastasis of advanced gastric cancer. Because missed metastasis can result in a poorer prognosis, we propose a systemic search including colonoscopy for patients with advanced gastric cancer, especially cases involving poorly differentiated adenocarcinoma or signet ring cell carcinoma.
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Affiliation(s)
- Takafumi Shima
- Minimally Invasive and Robot Surgery Center, Toyonaka Keijinkai Hospital, 1-8-12 Shoji, Toyonaka, Osaka, 560-0004, Japan.
| | - Asami Arita
- Minimally Invasive and Robot Surgery Center, Toyonaka Keijinkai Hospital, 1-8-12 Shoji, Toyonaka, Osaka, 560-0004, Japan
| | - Satoshi Sugimoto
- Minimally Invasive and Robot Surgery Center, Toyonaka Keijinkai Hospital, 1-8-12 Shoji, Toyonaka, Osaka, 560-0004, Japan
| | - Shoichi Takayama
- Minimally Invasive and Robot Surgery Center, Toyonaka Keijinkai Hospital, 1-8-12 Shoji, Toyonaka, Osaka, 560-0004, Japan
| | - Nao Kawaguchi
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Yoshiro Imai
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Tomohiro Kitahara
- Department of Gastroenterology, Toyonaka Keijinkai Hospital, 1-8-12 Shoji, Toyonaka, Osaka, 560-0004, Japan
| | - Tamaki Maeda
- Department of Pathology, Toyonaka Keijinkai Hospital, 1-8-12 Shoji, Toyonaka, Osaka, 560-0004, Japan
| | - Junji Okuda
- Minimally Invasive and Robot Surgery Center, Toyonaka Keijinkai Hospital, 1-8-12 Shoji, Toyonaka, Osaka, 560-0004, Japan
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Takeuchi D, Koide N, Suzuki A, Shimizu F, Koyama Y, Ehara T, Yamamoto Y, Koyama M, Nakamura S, Kitazawa M, Miyagawa Y, Miyagawa S. High incidence of other primary malignancies in patients with synchronous multiple gastric cancers "a multi-center retrospective cohort study". Oncotarget 2018; 9:20605-20616. [PMID: 29755675 PMCID: PMC5945523 DOI: 10.18632/oncotarget.25027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 03/19/2018] [Indexed: 12/26/2022] Open
Abstract
This study evaluated the relationship between synchronous multiple gastric cancer and other primary malignancies. During 2002–2013, 1094 consecutive surgically treated gastric cancer patients were enrolled. Preoperatively, we performed total colonoscopy and whole-body computed tomography. When malignancies in other organs were suspected, detailed organ-specific examinations were performed. Synchronous multiple gastric cancer occurred in 102 patients (9.3%)which was frequently observed in patients with preoperative other primary malignancies (p < 0.001). Preoperative other primary malignancy was an independent risk factor for synchronous multiple gastric cancer (p = 0.001; hazard ratio: 2.145, 95% confidence interval: 1.354–3.399) and an independent prognostic factor of overall survival in patients undergoing gastrectomy with curative intent (p = 0.021; hazard ratio: 1.481, 95% confidence interval: 1.060–2.070). Thus, patients with preoperative other primary malignancies have a high risk of synchronous multiple gastric cancer. Careful preoperative examination is recommended to improve survival.
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Affiliation(s)
- Daisuke Takeuchi
- Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto 390-8621, Japan
| | - Naohiko Koide
- Department of Surgery, Nagano Prefectural Kiso Hospital, Asahi, Matsumoto 390-8621, Japan
| | - Akira Suzuki
- Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto 390-8621, Japan
| | - Fumiaki Shimizu
- Department of Surgery, Shinshu Ueda Medical Center, Asahi, Matsumoto 390-8621, Japan
| | - Yoshinori Koyama
- Department of Surgery, Nagano Prefectural Kiso Hospital, Asahi, Matsumoto 390-8621, Japan
| | - Takehito Ehara
- Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto 390-8621, Japan
| | - Yuta Yamamoto
- Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto 390-8621, Japan
| | - Makoto Koyama
- Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto 390-8621, Japan
| | - Satoshi Nakamura
- Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto 390-8621, Japan
| | - Masato Kitazawa
- Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto 390-8621, Japan
| | - Yusuke Miyagawa
- Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto 390-8621, Japan
| | - Shinichi Miyagawa
- Department of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto 390-8621, Japan
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Choi BW, Kim HW, Won KS, Song BI, Cho KB, Bae SU. Diagnostic accuracy of 18F-FDG PET/CT for detecting synchronous advanced colorectal neoplasia in patients with gastric cancer. Medicine (Baltimore) 2016; 95:e4741. [PMID: 27603371 PMCID: PMC5023894 DOI: 10.1097/md.0000000000004741] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Preoperative screening for synchronous colorectal neoplasia (CRN) has been recommended in patients with gastric cancer because patients with gastric cancer are at increased risk for synchronous CRN. The aim of this study was to investigate the diagnostic accuracy of F-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) for detecting synchronous advanced CRN in patients with gastric cancer.A total of 256 patients who underwent colonoscopy and F-FDG PET/CT for preoperative staging were enrolled in this study. The diagnosis of focal colonic F-FDG uptake on F-FDG PET/CT image was made based on histopathologic results from the colonoscopic biopsy. The F-FDG PET/CT result was considered as true positive for advanced CRN when focal F-FDG uptake matched colorectal carcinoma or adenoma with high-grade dysplasia in the same location on colonoscopy.Synchronous advanced CRN was detected in 21 of the 256 patients (4.7%). Sensitivity, specificity, and accuracy of F-FDG PET/CT were 76.2%, 96.2%, and 94.5%. The size of CRN with a true positive result was significantly larger than that with a false negative result.F-FDG PET/CT demonstrated high diagnostic accuracy for detecting synchronous advanced CRN in patients with gastric cancer. Colonoscopy is recommended as the next diagnostic step for further evaluation of a positive F-FDG PET/CT result in patients with gastric cancer.
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Affiliation(s)
- Byung Wook Choi
- Department of Nuclear Medicine
- Correspondence: Hae Won Kim, Department of Nuclear Medicine, Keimyung University Dongsan Medical Center, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Republic of Korea (e-mail: ); Byung Wook Choi, Department of Nuclear Medicine, Keimyung University, School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Republic of Korea (e-mail: )
| | - Hae Won Kim
- Department of Nuclear Medicine
- Correspondence: Hae Won Kim, Department of Nuclear Medicine, Keimyung University Dongsan Medical Center, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Republic of Korea (e-mail: ); Byung Wook Choi, Department of Nuclear Medicine, Keimyung University, School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Republic of Korea (e-mail: )
| | | | | | | | - Sung Uk Bae
- Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
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Clinicopathologic features of gastric cancer with synchronous and metachronous colorectal cancer in Korea: are microsatellite instability and p53 overexpression useful markers for predicting colorectal cancer in gastric cancer patients? Gastric Cancer 2016; 19:798-807. [PMID: 26445944 DOI: 10.1007/s10120-015-0552-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 09/22/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND A large-scale study was performed to identify the risk factors for developing synchronous and metachronous colorectal cancer (CRC) in gastric cancer (GC) patients, including microsatellite instability (MSI) and p53 overexpression. METHODS A total of 1041 GC patients who underwent endoscopic resection or surgery and underwent colonoscopy simultaneously or during surveillance for GC were consecutively enrolled. Clinicopathologic characteristics, MSI, and p53 overexpression were compared between the GC patients with and those without synchronous and metachronous CRC. RESULTS Of the 1041 patients, CRCs were detected in 67 (6.4 %) patients with GC. Forty-six (4.4 %) had synchronous CRC and 21 (2.0 %) had metachronous CRC. Univariate analysis indicated that age ≥63 years (P < 0.001), male sex (P = 0.005), and p53 overexpression (P = 0.040) were significantly associated with a higher incidence of CRC. However, body mass index, smoking, tumor location, tumor multiplicity, tumor histology, TNM stage, and MSI were not significantly associated with the incidence of CRC. Age ≥63 years (OR: 5.881; 95 % CI: 3.083-11.221; P < 0.001) and male sex (OR: 2.933; 95 % CI: 1.307-6.584; P = 0.009) were risk factors for CRC in GC patients according to multivariate analysis. CONCLUSIONS GC patients who are male and/or ≥63 years old are recommended to receive colonoscopy to detect CRC. MSI and p53 overexpression were not useful molecular markers for predicting CRC in GC.
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