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Langenbeck's Archives of Surgery

, Volume 394, Issue 1, pp 93–97 | Cite as

Gastric remnant cancer: an old problem with novel concerns

  • Ozgur Firat
  • Adem Guler
  • Murat Sozbilen
  • Sinan Ersin
  • Hasan Kaplan
Original Article

Abstract

Background and aims

The patients with cancers in the remnant stomachs after previous partial resections for benign diseases constitute a peculiar subset of the patients with gastric cancer. They are generally at advanced stages on admissions due to disregarding the symptoms related to cancer.

Patients and methods

Twenty six patients with cancer arising from the remnant stomach were analyzed. Clinicopathologic features such as age, gender, time interval between the initial operation and diagnosis of gastric remnant cancer, preoperative symptoms, surgical management, and tumor characteristics like size, location, histopathology, depth of invasion, lymph node involvement, presence of distant metastasis, and stages were documented.

Results

None of the cancers were diagnosed by routine surveillance and all the patients were symptomatic at the time of diagnosis. Twenty five patients were qualified for surgery. The resectability rate was 61% (n = 16). The ability to perform a curative resection and tumor location at the anastomotic site were determined as the factors significantly influencing survival (p < 0.05).

Conclusion

Curative resection has to be the goal of surgical management in patients with gastric remnant cancer. Concerning clinician should be sceptical about a newly developing cancer in order to detect it in an early stage and enhance resectability.

Keywords

Gastric remnant cancer Curative resection Survival 

References

  1. 1.
    Ohashi M, Katai H, Fukagawa T, Gotoda T, Sano T, Sasako M (2007) Cancer of the gastric stump following distal gastrectomy for cancer. Br J Surg 94(1):92–95 doi: 10.1002/bjs.5538 PubMedCrossRefGoogle Scholar
  2. 2.
    Thorban S, Böttcher K, Etter M, Roder JD, Busch R, Siewert JR (2000) Prognostic factors in gastric stump carcinoma. Ann Surg 231(2):188–194 doi: 10.1097/00000658-200002000-00006 PubMedCrossRefGoogle Scholar
  3. 3.
    Safatle-Ribeiro AV, Ribeiro U Jr, Reynolds JC (1998) Gastric stump cancer: what is the risk? Dig Dis 16(3):159–168 doi: 10.1159/000016860 PubMedCrossRefGoogle Scholar
  4. 4.
    Kodera Y, Yamamura Y, Torii A, Uesaka K, Hirai T, Yasui K et al (1996) Gastric stump carcinoma after partial gastrectomy for benign gastric lesion: what is feasible as standard surgical treatment? J Surg Oncol 63(2):119–124 doi: 10.1002/(SICI)1096-9098(199610)63:2<119::AID-JSO9>3.0.CO;2-H PubMedCrossRefGoogle Scholar
  5. 5.
    Orlando R 3rd, Welch JP (1981) Carcinoma of the stomach after gastric operation. Am J Surg 141(4):487–491 doi: 10.1016/0002-9610(81)90145-8 PubMedCrossRefGoogle Scholar
  6. 6.
    Han SL, Hua YW, Wang CH, Ji SQ, Zhuang J (2003) Metastatic pattern of lymph node and surgery for gastric stump cancer. J Surg Oncol 82(4):241–246 doi: 10.1002/jso.10228 PubMedCrossRefGoogle Scholar
  7. 7.
    Imada T, Rino Y, Takahashi M, Shiozawa M, Hatori S, Noguchi Y et al (1998) Clinicopathologic differences between gastric remnant cancer and primary cancer in the upper third of the stomach. Anticancer Res 18(1A):231–235PubMedGoogle Scholar
  8. 8.
    An JY, Choi MG, Noh JH, Sohn TS, Kim S (2007) The outcome of patients with remnant primary gastric cancer compared with those having upper one-third gastric cancer. Am J Surg 194(2):143–147 doi: 10.1016/j.amjsurg.2006.10.034 PubMedCrossRefGoogle Scholar
  9. 9.
    Schaefer N, Sinning C, Standop J, Overhaus M, Hirner A, Wolff M (2007) Treatment and prognosis of gastric stump carcinoma in comparison with primary proximal gastric cancer. Am J Surg 194(1):63–67 doi: 10.1016/j.amjsurg.2006.12.037 PubMedCrossRefGoogle Scholar
  10. 10.
    Newman E, Brennan MF, Hochwald SN, Harrison LE, Karpeh MS Jr (1997) Gastric remnant carcinoma: just another proximal gastric cancer or a unique entity? Am J Surg 173(4):292–297 doi: 10.1016/S0002-9610(96)00403-5 PubMedCrossRefGoogle Scholar
  11. 11.
    Balfour DC (1922) Factors influencing the life expectancy of patients operated on for gastric ulcer. Ann Surg 76(3):405–408 doi: 10.1097/00000658-192209000-00014 PubMedCrossRefGoogle Scholar
  12. 12.
    Sobin LH, Wittekind C (eds) (2002) TNM Classification of malignant tumors (6th ed). Wiley-Liss, New YorkGoogle Scholar
  13. 13.
    Sinning C, Schaefer N, Standop J, Hirner A, Wolff M (2007) Gastric stump carcinoma-epidemiology and current concepts in pathogenesis and treatment. Eur J Surg Oncol 33(2):133–139 doi: 10.1016/j.ejso.2006.09.006 PubMedCrossRefGoogle Scholar
  14. 14.
    Kondo K (2002) Duodenogastric reflux and gastric stump carcinoma. Gastric Cancer 5(1):16–22 doi: 10.1007/s101200200002 PubMedCrossRefGoogle Scholar
  15. 15.
    Tanigawa N, Nomura E, Niki M, Shinohara H, Nishiguchi K, Okuzawa M et al (2002) Clinical study to identify specific characteristics of cancer newly developed in the remnant stomach. Gastric Cancer 5(1):23–28 doi: 10.1007/s101200200003 PubMedCrossRefGoogle Scholar
  16. 16.
    Takeno S, Noguchi T, Kimura Y, Fujiwara S, Kubo N, Kawahara K (2006) Early and late gastric cancer arising in the remnant stomach after distal gastrectomy. Eur J Surg Oncol 32(10):1191–1194 doi: 10.1016/j.ejso.2006.04.018 PubMedCrossRefGoogle Scholar
  17. 17.
    Kondo K, Kojima H, Akiyama S, Ito K, Takagi H (1995) Pathogenesis of adenocarcinoma induced by gastrojejunostomy in Wistar rats: role of duodenogastric reflux. Carcinogenesis 16(8):1747–1751 doi: 10.1093/carcin/16.8.1747 PubMedCrossRefGoogle Scholar
  18. 18.
    Kaminishi M, Shimizu N, Shiomoyama S, Yamaguchi H, Ogawa T, Sakai S, Kuramoto S, Oohara T (1995) Etiology of gastric remnant cancer with special reference to the effects of denervation of the gastric mucosa. Cancer 75(6 Suppl):1490–1496 15;PubMedCrossRefGoogle Scholar
  19. 19.
    Nakanishi I, Sowa M, Otani S (1993) Ornithine decarboxylase activity in the mucosa of gastric remnant following gastric surgery. Cancer Epidemiol Biomarkers Prev 2(6):569–572PubMedGoogle Scholar
  20. 20.
    Kitao Y, Yamane T, Kikuoka N, Matsumoto H, Oya K, Inagake M et al (1994) Risk analysis of carcinogenesis in the remnant stomach with measurement of ornithine decarboxylase activity. J Surg Oncol 57(1):22–24 doi: 10.1002/jso.2930570107 PubMedCrossRefGoogle Scholar
  21. 21.
    Ehrnström RA, Bjursten LM, Ljungberg O, Veress B, Haglund ME, Lindström CG, Andersson T (2008) Dietary supplementation with carbonate increases expression of ornithine decarboxylase and proliferation in gastric mucosa in a rat model of gastric cancer. Int J Cancer 122(4):727–733 15;PubMedCrossRefGoogle Scholar
  22. 22.
    Furukawa H, Iwanaga T, Hiratsuka M, Imaoka S, Ishikawa O, Kabuto T et al (1993) Gastric remnant cancer as a metachronous multiple lesion. Br J Surg 80(1):54–56 doi: 10.1002/bjs.1800800120 PubMedCrossRefGoogle Scholar
  23. 23.
    Sasako M, Maruyama K, Kinoshita T, Okabayashi K (1991) Surgical treatment of carcinoma of the gastric stump. Br J Surg 78(7):822–824 doi: 10.1002/bjs.1800780718 PubMedCrossRefGoogle Scholar
  24. 24.
    Piso P, Meyer HJ, Edris C, Jähne J (1999) Surgical therapy of gastric stump carcinoma—a retrospective analysis of 109 patients. Hepatogastroenterology 46(28):2643–2647PubMedGoogle Scholar
  25. 25.
    Ikeguchi M, Kondou A, Shibata S, Yamashiro H, Tsujitani S, Maeta M et al (1994) Clinicopathologic differences between carcinoma in the gastric remnant stump after distal partial gastrectomy for benign gastroduodenal lesions and primary carcinoma in the upper third of the stomach. Cancer 73(1):15–21 doi: 10.1002/1097-0142(19940101)73:1<15::AID-CNCR2820730105>3.0.CO;2-J PubMedCrossRefGoogle Scholar
  26. 26.
    Lacaine F, Houry S, Huguier M (1992) Stomach cancer after partial gastrectomy for benign ulcer disease. A critical analysis of epidemiological reports. Hepatogastroenterology 39(1):4–8PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Ozgur Firat
    • 1
  • Adem Guler
    • 1
  • Murat Sozbilen
    • 1
  • Sinan Ersin
    • 1
  • Hasan Kaplan
    • 1
  1. 1.Department of General SurgeryEge University HospitalBornovaTurkey

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