As the utilization of computed tomography in lung cancer screening becomes more prevalent in the post-pandemic era, the incidence of multiple primary lung cancer (MPLC) has surged in various countries and regions. Despite the continued application of advanced histologic and sequencing technologies in this research field, the differentiation between MPLC and intrapulmonary metastasis (IM) remains challenging. In recent years, the specific mechanisms of genetic and environmental factors in MPLC have gradually come to light. Lobectomy still predominates in the treatment of MPLC, but the observation that tumor-specific sublobar resection has not detrimentally impacted survival appears to be a viable option. With the evolution of paradigms, the amalgamated treatment, primarily surgical, is an emerging trend. Among these, stereotactic ablative radiotherapy (SABR) and lung ablation techniques have emerged as efficacious treatments for early unresectable tumors and control of residual lesions. Furthermore, targeted therapies for driver-positive mutations and immunotherapy have demonstrated promising outcomes in the postoperative adjuvant phase. In this manuscript, we intend to provide an overview of the management of MPLC based on the latest discoveries.
.
Humans ; Lung Neoplasms/therapy* ; Early Detection of Cancer ; Lung/surgery* ; Treatment Outcome ; Radiosurgery/methods* ; Neoplasms, Multiple Primary/pathology*

Female ; Humans ; Melanoma/surgery* ; Neoplasms, Multiple Primary/pathology* ; Ovarian Neoplasms/pathology* ; Skin Neoplasms ; Teratoma/surgery*

Located in the pelvic cavity and contiguous to the anal sphincter complex and urogenital organs, the rectum has more intricate anatomical features compared with the colon. Consequently, the treatment of rectal cancer involves more consideration, including pelvic radiation, lateral lymph node dissection, transanal access, postoperative function, sphincter preservation, and nonoperative management. Based on the last set of American society of colon and rectal surgeons (ASCRS) practice parameters for the management of rectal cancer published in 2013, the 2020 guidelines present evidence-based updates for both long-existing and emerging controversies on surgical management of rectal cancer. These updates include the indication for local resection, lymph node dissection for radical proctectomy, minimally invasive surgery, the "watch and wait" strategy for patients with clinical complete response, and prevention of anastomotic leak. Meanwhile, the guidelines recommend a risk-stratified approach for perioperative therapies for non-metastatic disease, and an individualized multimodality treatment based on treatment intent for synchronous metastatic disease.
Humans ; Lymph Node Excision ; Neoplasms, Multiple Primary/therapy* ; Practice Guidelines as Topic ; Proctectomy ; Rectal Neoplasms/therapy* ; Rectum/surgery* ; United States

BACKGROUND: Simultaneity multiple primary lung cancer always is a rare disease, but in recent years due to the progress of the diagnosis and treatment means detection rate increased. This study summarized the clinical data of 31 cases of synchronous multiple primary lung cancer (sMPLC) analysis, further to explore the diagnosis, treatment and prognosis of MPLC. METHODS: Sum up the clinical data of 31 cases of simultaneous multiple primary lung cancer, the diagnostic method, surgical methods, pathology, were retrospectively analyzed. RESULTS: All the patients are thoracoscope surgery, no deaths. Thin high resolution computed tomography (CT) in preoperative found multiple lung nodules. Lesions located in the same side of the same period surgical treatment, the operation method is given priority to with under the thoracoscope lung + the lobectomy; Lesions located in bilateral, all staged operation, the time interval for 3 months-4 months. CONCLUSIONS Thin layer distinguish CT preoperative diagnosis is the best way to simultaneous multiple primary lung cancer. Multiple primary lung cancer incidence of ipsilateral lung at the same time higher than that of bilateral lung (23:8), type, around 94%, the most common histology to adenocarcinoma, 80.6% (25/31). Primary lesions under thoracoscope lobectomy plus the lobectomy of secondary lesions is the most commonly used.
Adult ; Aged ; Female ; Humans ; Lung Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Neoplasms, Multiple Primary ; diagnosis ; diagnostic imaging ; surgery ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Microsatellite instability (MSI) plays a crucial role in gastrointestinal carcinogenesis. The aim of this study was to clarify whether MSI is a useful marker for predicting synchronous gastric and colorectal neoplasms. METHODS: Consecutive patients who underwent both esophagogastroduodenoscopy and colonoscopy before the resection of gastric or colorectal cancers were included. MSI was analyzed using two mononucleotide and three dinucleotide markers. RESULTS: In total, 434 gastric cancers (372 microsatellite stability [MSS], 21 low incidence of MSI [MSI-L], and 41 high incidence of MSI [MSI-H]) and 162 colorectal cancers (138 MSS, 9 MSI-L, and 15 MSI-H) were included. Patients with MSI gastric cancer had a higher prevalence of synchronous colorectal cancer, colorectal adenoma, and gastric adenoma than those with MSS gastric cancers (4.8% vs 0.5%, p=0.023; 11.3% vs 3.2%, p=0.011; 3.2% vs 1.2%, p=0.00, respectively). The prevalence of synchronous colorectal adenomas was highest in MSI-L gastric cancers (19.0%), compared with MSI-H (7.3%) or MSS (3.2%) gastric cancers (p=0.002). In addition, there were no significant differences in the prevalence rates of synchronous colorectal adenoma among the MSI-H (13.3%), MSI-L (11.1%), and MSS (12.3%) colorectal cancers (p=0.987). CONCLUSIONS: The presence of MSI in gastric cancer may be a predictor of synchronous gastric and colorectal neoplasms, whereas MSI in colorectal cancer is not a predictor of synchronous colorectal adenoma.
Adenoma/*genetics/surgery ; Aged ; Colonoscopy ; Colorectal Neoplasms/*genetics/surgery ; Endoscopy, Digestive System ; Female ; Humans ; Male ; *Microsatellite Instability ; Middle Aged ; Neoplasms, Multiple Primary/*genetics/surgery ; Predictive Value of Tests ; Stomach Neoplasms/*genetics/surgery

BACKGROUND/AIMS: We investigated the clinical outcomes according to the method of treatment in synchronous esophageal and gastric cancer. METHODS: Synchronous esophageal squamous cell carcinoma and gastric adenocarcinoma were diagnosed in 79 patients between 1996 and 2010. We divided the patients into four groups according to treatment; Group 1 received surgical resection for both cancers or surgery for gastric cancer with chemoradiotherapy for esophageal cancer (n=27); Group 2 was treated by endoscopic resection with or without additional treatment (n=14); Group 3 received chemoradiotherapy only (n=18); and Group 4 received supportive care only (n=20). RESULTS: The median survival times in groups 1 and 2 were 86 and 60 months, respectively. The recurrence rate and mortality were 23% and 48%, respectively, in group 1 and 21% and 4%, respectively, in group 2. The median survival time was 12 months in group 3 and 9 months in group 4. Multivariate analysis showed that age (p<0.001) and treatment group (p=0.019) were significantly associated with death. Compared with group 1, treatment in the intensive care unit (p=0.003), loss of body weight (p=0.042), and decrease in hemoglobin (p=0.033) were worse in group 1. CONCLUSIONS: Endoscopic resection for synchronous esophageal and gastric cancer could be considered as a possible alternative to surgery for early-stage cancer.
Adenocarcinoma/mortality/*surgery/therapy ; Aged ; Carcinoma, Squamous Cell/mortality/*surgery/therapy ; Combined Modality Therapy ; Endoscopy, Gastrointestinal/*methods ; Esophageal Neoplasms/mortality/*surgery/therapy ; Female ; Humans ; Male ; Middle Aged ; Neoplasms, Multiple Primary/mortality/*surgery/therapy ; Nutritional Status ; Risk Factors ; Stomach Neoplasms/mortality/*surgery/therapy ; Survival Analysis

No abstract available.
Adrenal Cortex Function Tests ; *Adrenal Cortex Neoplasms/complications/diagnosis/metabolism/surgery ; *Adrenal Gland Neoplasms/complications/diagnosis/metabolism/surgery ; Adrenalectomy ; *Adrenocortical Adenoma/complications/diagnosis/metabolism/surgery ; Biopsy ; Cushing Syndrome/diagnosis/etiology ; Female ; Humans ; Immunohistochemistry ; *Incidental Findings ; Middle Aged ; *Neoplasms, Multiple Primary/complications/diagnosis/metabolism/surgery ; *Pheochromocytoma/complications/diagnosis/metabolism/surgery ; Predictive Value of Tests ; Tomography, X-Ray Computed ; Treatment Outcome ; Tumor Markers, Biological/metabolism

BACKGROUND/AIMS: Synchronous/metachronous gastric epithelial neoplasias (GENs) in the remaining lesion can develop at sites other than the site of endoscopic resection. In the present study, we aimed to investigate the predictive value of serum pepsinogen for detecting multiple GENs in patients who underwent endoscopic resection. METHODS: In total, 228 patients with GEN who underwent endoscopic resection and blood collection for pepsinogen I and II determination were evaluated retrospectively. RESULTS: The mean period of endoscopic follow-up was 748.8+/-34.7 days. Synchronous GENs developed in 46 of 228 (20.1%) and metachronous GENs in 27 of 228 (10.6%) patients during the follow-up period. Multiple GENs were associated with the presence of pepsinogen I <30 ng/mL (p<0.001). Synchronous GENs were associated with the presence of pepsinogen I <30 ng/mL (p<0.001). CONCLUSIONS: Low pepsinogen I levels predict multiple GENs after endoscopic resection, especially synchronous GENs. Cautious endoscopic examination prior to endoscopic resection to detect multiple GENs should be performed for these patients.
Female ; Gastroscopy ; Humans ; Male ; Middle Aged ; Neoplasms, Glandular and Epithelial/*diagnosis/surgery ; Neoplasms, Multiple Primary/*diagnosis/surgery ; Pepsinogen A/*deficiency ; Predictive Value of Tests ; Retrospective Studies ; Stomach Neoplasms/*diagnosis/surgery

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) has become accepted as a minimally invasive treatment for gastric neoplasms. However, the development of synchronous or metachronous gastric lesions after endoscopic resection has become a major problem. We investigated the characteristics of multiple gastric neoplasms in patients with early gastric cancer (EGC) or gastric adenoma after ESD. METHODS: In total, 512 patients with EGC or gastric adenoma who had undergone ESD between January 2008 and December 2011 participated in this study. The incidence of and factors associated with synchronous and metachronous gastric tumors were investigated in this retrospective study. RESULTS: In total, 66 patients (12.9%) had synchronous lesions, and 13 patients (2.5%) had metachronous lesions. Older (> 65 years) subjects had an increased risk of multiple gastric neoplasms (p = 0.012). About two-thirds of the multiple lesions were similar in macroscopic and histological type to the primary lesions. The median interval from the initial lesions to the diagnosis of metachronous lesions was 31 months. The annual incidence rate of metachronous lesions was approximately 3%. CONCLUSIONS: We recommend careful follow-up in patients of advanced age (> 65 years) after initial ESD because multiple lesions could be detected in the remnant stomach. Annual surveillance might aid in the detection of metachronous lesions. Large-scale, multicenter, and longer prospective studies of appropriate surveillance programs are needed.
Adenoma/epidemiology/pathology/*surgery ; Age Factors ; Aged ; *Dissection ; Female ; Gastrectomy/*methods ; Gastric Mucosa/pathology/*surgery ; *Gastroscopy ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasms, Multiple Primary/epidemiology/pathology/*surgery ; Neoplasms, Second Primary/epidemiology/pathology/*surgery ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms/epidemiology/pathology/*surgery ; Time Factors ; Treatment Outcome

Gastrointestinal neuroendocrine tumors arise from cells of the diffuse neuroendocrine system and can take place almost anywhere within the gastrointestinal tract. A 40-year-old man admitted to evaluate a duodenal subepithelial lesion which was incidentally found at health check-up. The polypoid duodenal subepithelial lesion, measuring about 7 mm, was removed by the endoscopic mucosal resection and the pathology confirmed a neuroendocrine tumor. Abdominopelvic computed tomography, done for staging work up, revealed a mass in the pancreatic head and the patient received pylorus preserving pancreaticoduodenectomy. Mass at the pancreas also found out to be neuroendocrine tumor but showed different histopathologic traits under immunohistochemical staining. The patient was also diagnosed as hyperparathyroidism and pituitary microadenoma. Finally, multiple endocrine neoplasia type 1 was confirmed, which was accompanied by duodenal neuroendocrine tumor.
Adult ; Antigens, CD56/metabolism ; Duodenum/*pathology ; Endoscopy, Digestive System ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Male ; Neoplasms, Multiple Primary ; Neuroendocrine Tumors/*diagnosis/metabolism/surgery ; Pancreas/*pathology ; Synaptophysin/metabolism ; Tomography, X-Ray Computed