Gastric Cancer

, Volume 12, Issue 2, pp 118–122 | Cite as

Duodenal stump cancer after Billroth-II distal gastrectomy for gastric cancer

  • Junhyun Lee
  • Kyungji Lee
  • Wook Kim
Case Report


Duodenal cancer is an uncommon neoplasm and it mostly arises from the periampullary area. However, metachronous or even recurrent cancer at the duodenal stump following Billroth II type distal gastrec tomy for gastric cancer is extremely rare and, to our knowledge, has not yet been reported. A 68-year-old man underwent Billroth II distal gastrectomy with D2 lymph node dissection for an advanced gastric cancer. At that time the tumor stage was T2bN3M0, with 44 of 78 retrieved lymph nodes showing metastasis. He was well without recurrence for 3 years; however, he visited our hospital because of the abrupt onset of dizziness and tarry stool. A polypoid tumor that bled easily when touched was found at the end of the afferent loop of the duodenal stump by gastrofiberscopic examination, and it was proven to be an adenocarcinoma by endoscopic biopsy. Fortunately, additional studies, including abdominal computed tomography and positron emission tomography-computed tomography, showed no other sites of recurrence. The patient underwent pancreaticoduodenectomy for local control of the recurrent tumor at the duodenal stump, and the pathologic findings, based on immunohistochemical staining, strongly suggested that the duodenal tumor was metachronous in nature rather than recurrent.

Key words

Advanced gastric cancer Recurrence Metachronous cancer Duodenal stump 


  1. 1.
    Eom BW, Lee HJ, Yoo MW, Cho JJ, Kim WH, Yang HK, et al. Synchronous and metachronous cancers in patients with gastric cancer. J Surg Oncol 2008;98:106–110.PubMedCrossRefGoogle Scholar
  2. 2.
    Ikeda Y, Saku M. Kawanaka H, Nonaka M, Yoshida K. Features of second primary cancer in patients with gastric cancer. Oncology 2003;65:113–117.PubMedCrossRefGoogle Scholar
  3. 3.
    Dinis-Ribeiro M, Lomba-Viana H, Silva R, Moreira-Dias L, Lomba-Viana R. Associated primary tumors in patients with gastric cancer. J Clin Gastroenterol 2002;34:533–555.PubMedCrossRefGoogle Scholar
  4. 4.
    Saito H, Tsujitani S, Kondo A, Ikeguchi M, Maeta M, Kaibara N. Expression of vascular endothelial growth factor correlates with hematogenous recurrence in gastric carcinoma. Surgery 1999;125:195–201.PubMedGoogle Scholar
  5. 5.
    Jadvar H, Tatlidil R, Garcia AA, Conti PS. Evaluation of recurrent gastric malignancy with [F-18]-FDG positron emission tomography. Clin Radiol 2003;58:215–221.PubMedCrossRefGoogle Scholar
  6. 6.
    Lim JS, Yun MJ, Kim MJ, Hyung WJ, Park MS, Choi JY, et al. CT and PET in the stomach cancer: preoperative staging and monitoring of response to therapy. Radiographics 2006;26:143–156.PubMedCrossRefGoogle Scholar
  7. 7.
    Lee HS, Lee HK, Kim HS, Yang HK, Kim YI, Kim WH. MUC1, MUC2, MUC5AC, and MUC6 expressions in gastric carcinomas: their roles as prognostic indicators. Cancer 2001;92:1427–1434.PubMedCrossRefGoogle Scholar
  8. 8.
    Iovine VM, Tsangaris N. Primary carcinoma on the duodenum. Am Surg 1961;27:744–750.Google Scholar
  9. 9.
    Ryder NM, Ko CY, Hines OJ, Gloor B, Reber HA. Primary duodenal adenocarcinoma. Arch Surg 2000;135:1070–1075.PubMedCrossRefGoogle Scholar
  10. 10.
    Scott-Coombes DM, Williamson RCN. Surgical treatment of primary duodenal carcinoma: a personal series. Br J Surg 1994;81:1472–1474.PubMedCrossRefGoogle Scholar
  11. 11.
    Onoue S, Katoh T, Chigira H, Matsuo K, Suzuki M, Shibata Y, et al. Synchronous multiple primary cancers of the stomach and duodenum in aged patients: report of two cases. Surg Today 2000;30:735–738.PubMedCrossRefGoogle Scholar
  12. 12.
    Yoo CH, Noh SH, Shin DW. Recurrence following curative resection for gastric carcinoma. Br J Surg 2000;87:236–242.PubMedCrossRefGoogle Scholar
  13. 13.
    Song KY, Park SM, Kim SM, Park CH. The role of surgery in the treatment of recurrent gastric cancer. Am J Surg 2008;196:19–22.PubMedCrossRefGoogle Scholar
  14. 14.
    Shchepotin I, Evans SR, Shabahang M, Cherny M, Buras MM, Zadorozhny A. Radical treatment of locally recurrent gastric cancer. Am Surg 1995;6:371–376.Google Scholar

Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2009

Authors and Affiliations

  • Junhyun Lee
    • 1
  • Kyungji Lee
    • 2
  • Wook Kim
    • 1
  1. 1.Department of Surgery, Holy Family Hospital, College of MedicineThe Catholic University of KoreaBucheon, GyunggiKorea
  2. 2.Department of Hospital Pathology, Holy Family Hospital, College of MedicineThe Catholic University of KoreaBucheon, GyunggiKorea

Personalised recommendations