World Journal of Surgery

, Volume 34, Issue 7, pp 1548–1554 | Cite as

Risk Factors for Metachronous Gastric Cancer in the Remnant Stomach After Early Cancer Surgery

  • Isao Nozaki
  • Junichirou Nasu
  • Yoshiro Kubo
  • Minoru Tanada
  • Rieko Nishimura
  • Akira Kurita



Early gastric cancer patients have a good prognosis after radical resection. However, if the patients have a gastric remnant after the surgery, the risk of metachronous gastric cancer remains. The aim of this study was to clarify the risk factors for metachronous gastric cancer after partial gastrectomy for early gastric cancer.


Data on a series of 1281 consecutive gastrectomy patients with pathologically confirmed early gastric cancer from 1991 to 2007 in Shikoku Cancer Center were analyzed retrospectively.


The gastric remnants of 868 patients were periodically surveyed by endoscopic examination. Among those surveyed cases, 26 patients were diagnosed as having metachronous gastric cancer in the gastric remnant. They underwent curative resection by remnant gastrectomy (n = 13 patients) or endoscopic mucosal resection (n = 13 patients). Multivariate analysis showed that male sex, older age, submucosal invasion, and proximal gastrectomy were independent risk factors.


Our data suggested that more intensive endoscopic follow-up is needed for the remnant stomach in patients with these risk factors to detect metachronous gastric cancer at its early stage.



We thank Dr. Koji Ohta and Dr. Takaya Kobatake, who gave us insightful comments and suggestions for this study.


  1. 1.
    Parkin DM (2001) Global cancer statistics in the year 2000. Lancet Oncol 2:533–543CrossRefPubMedGoogle Scholar
  2. 2.
    Maruyama K, Kaminishi M, Hayashi K et al (2006) Gastric cancer treated in 1991 in Japan: data analysis of nationwide registry. Gastric Cancer 9:51–66CrossRefPubMedGoogle Scholar
  3. 3.
    Ikeda Y, Saku M, Kishihara F et al (2005) Effective follow-up for recurrence or a second primary cancer in patients with early gastric cancer. Br J Surg 92:235–239CrossRefPubMedGoogle Scholar
  4. 4.
    Furukawa H, Iwanaga T, Hiratsuka M et al (1993) Gastric remnant cancer as a metachronous multiple lesion. Br J Surg 80:54–56CrossRefPubMedGoogle Scholar
  5. 5.
    Kitano S, Shiraishi N, Uyama I et al (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72CrossRefPubMedGoogle Scholar
  6. 6.
    Onodera H, Tokunaga A, Yoshiyuki T et al (2004) Surgical outcome of 483 patients with early gastric cancer: prognosis, postoperative morbidity and mortality, and gastric remnant cancer. Hepatogastroenterology 51:82–85PubMedGoogle Scholar
  7. 7.
    Hosokawa O, Kaizaki Y, Watanabe K et al (2002) Endoscopic surveillance for gastric remnant cancer after early cancer surgery. Endoscopy 34:469–473CrossRefPubMedGoogle Scholar
  8. 8.
    Tersmette AC, Goodman SN, Offerhaus GJ et al (1991) Multivariate analysis of the risk of stomach cancer after ulcer surgery in an Amsterdam cohort of postgastrectomy patients. Am J Epidemiol 134:14–21PubMedGoogle Scholar
  9. 9.
    Tersmette AC, Offerhaus GJ, Tersmette KW et al (1990) Meta-analysis of the risk of gastric stump cancer: detection of high risk patient subsets for stomach cancer after remote partial gastrectomy for benign conditions. Cancer Res 50:6486–6489PubMedGoogle Scholar
  10. 10.
    Tokudome S, Kono S, Ikeda M et al (1984) A prospective study on primary gastric stump cancer following partial gastrectomy for benign gastroduodenal diseases. Cancer Res 44:2208–2212PubMedGoogle Scholar
  11. 11.
    Association Japanese Gastric Cancer (1998) Japanese classification of gastric carcinoma, 2nd English Edition. Gastric Cancer 1:10–24Google Scholar
  12. 12.
    Shibata C, Shiiba KI, Funayama Y et al (2004) Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial. World J Surg 28:857–861CrossRefPubMedGoogle Scholar
  13. 13.
    Katai H, Sano T, Fukagawa T et al (2003) Prospective study of proximal gastrectomy for early gastric cancer in the upper third of the stomach. Br J Surg 90:850–853CrossRefPubMedGoogle Scholar
  14. 14.
    Ohgami M, Otani Y, Kumai K et al (1999) Curative laparoscopic surgery for early gastric cancer: five years experience. World J Surg 23:187–192CrossRefPubMedGoogle Scholar
  15. 15.
    Nozaki I, Kurita A, Nasu J et al (2007) Higher incidence of gastric remnant cancer after proximal than distal gastrectomy. Hepatogastroenterology 54:1604–1608PubMedGoogle Scholar
  16. 16.
    Nasu J, Doi T, Endo H et al (2005) Characteristics of metachronous multiple early gastric cancers after endoscopic mucosal resection. Endoscopy 37:990–993CrossRefPubMedGoogle Scholar
  17. 17.
    Kang GH, Kim CJ, Kim WH et al (1997) Genetic evidence for the multicentric origin of synchronous multiple gastric carcinoma. Lab Invest 76:407–417PubMedGoogle Scholar
  18. 18.
    Lee JH, Abraham SC, Kim HS et al (2002) Inverse relationship between APC gene mutation in gastric adenomas and development of adenocarcinoma. Am J Pathol 161:611–618PubMedGoogle Scholar
  19. 19.
    Miyoshi E, Haruma K, Hiyama T et al (2001) Microsatellite instability is a genetic marker for the development of multiple gastric cancers. Int J Cancer 95:350–353CrossRefPubMedGoogle Scholar
  20. 20.
    Ohtani H, Yashiro M, Onoda N et al (2000) Synchronous multiple primary gastrointestinal cancer exhibits frequent microsatellite instability. Int J Cancer 86:678–683CrossRefPubMedGoogle Scholar
  21. 21.
    Latournerie M, Jooste V, Cottet V et al (2008) Epidemiology and prognosis of synchronous colorectal cancers. Br J Surg 95:1528–1533CrossRefPubMedGoogle Scholar
  22. 22.
    Lee JH, Bae JS, Ryu KW et al (2006) Gastric cancer patients at high-risk of having synchronous cancer. World J Gastroenterol 12:2588–2592PubMedGoogle Scholar
  23. 23.
    Yamamoto M, Yamanaka T, Baba H et al (2008) The postoperative recurrence and the occurrence of second primary carcinomas in patients with early gastric carcinoma. J Surg Oncol 97:231–235CrossRefPubMedGoogle Scholar
  24. 24.
    Kaneko K, Kondo H, Saito D et al (1998) Early gastric stump cancer following distal gastrectomy. Gut 43:342–344CrossRefPubMedGoogle Scholar
  25. 25.
    Kosaka T, Miwa K, Yonemura Y et al (1990) A clinicopathologic study on multiple gastric cancers with special reference to distal gastrectomy. Cancer 65:2602–2605CrossRefPubMedGoogle Scholar
  26. 26.
    Honmyo U, Misumi A, Murakami A et al (1989) Clinicopathological analysis of synchronous multiple gastric carcinoma. Eur J Surg Oncol 15:316–321PubMedGoogle Scholar
  27. 27.
    Domellof L (1979) Gastric carcinoma promoted by alkaline reflux gastritis: with special reference to bile and other surfactants as promoters of postoperative gastric cancer. Med Hypotheses 5:463–476CrossRefPubMedGoogle Scholar
  28. 28.
    Matsukura N, Tajiri T, Kato S et al (2003) Helicobacter pylori eradication therapy for the remnant stomach after gastrectomy. Gastric Cancer 6:100–107PubMedGoogle Scholar
  29. 29.
    Nakagawara H, Miwa K, Nakamura S et al (2003) Duodenogastric reflux sustains Helicobacter pylori infection in the gastric stump. Scand J Gastroenterol 38:931–937CrossRefPubMedGoogle Scholar
  30. 30.
    Onoda N, Maeda K, Sawada T et al (2001) Prevalence of Helicobacter pylori infection in gastric remnant after distal gastrectomy for primary gastric cancer. Gastric Cancer 4:87–92CrossRefPubMedGoogle Scholar
  31. 31.
    Fukase K, Kato M, Kikuchi S et al (2008) Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet 372:392–397CrossRefPubMedGoogle Scholar
  32. 32.
    Shiotani A, Uedo N, Iishi H et al (2008) Predictive factors for metachronous gastric cancer in high-risk patients after successful Helicobacter pylori eradication. Digestion 78:113–119CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Isao Nozaki
    • 1
  • Junichirou Nasu
    • 2
  • Yoshiro Kubo
    • 1
  • Minoru Tanada
    • 1
  • Rieko Nishimura
    • 3
  • Akira Kurita
    • 1
  1. 1.Department of Surgery, Division of Gastroenterology, National Hospital OrganizationShikoku Cancer CenterMatsuyamaJapan
  2. 2.Department of Internal Medicine, National Hospital OrganizationShikoku Cancer CenterMatsuyamaJapan
  3. 3.Department of Pathology, National Hospital OrganizationShikoku Cancer CenterMatsuyamaJapan

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