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Differences of the Lymphatic Distribution and Surgical Outcomes Between Remnant Gastric Cancers and Primary Proximal Gastric Cancers

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Journal of Gastrointestinal Surgery



Although remnant gastric cancer (RGC) following distal gastrectomy is located in the proximal stomach, little is known about the differences of the lymphatic distribution and surgical outcomes between RGC and primary proximal gastric cancer (PGC).


Between 1997 and 2008, 1,149 patients underwent gastrectomy for gastric cancer. Of these, 33 (2.9%) RGC patients and 207 (18.5%) PGC patients were treated at our department. We reviewed their hospital records retrospectively.


Compared with the PGC patients, those with RGC had a slightly higher age at onset (p = 0.09), higher incidence of undifferentiated cancer (p = 0.06), higher incidence of vascular invasion (p = 0.09), and higher incidence of T4 (p = 0.07). Gastrectomy for RGC involved greater blood loss (p < 0.005), longer surgical duration (p = 0.01), combined resection, and high incidence of complications. However, the survival rate for RGC patients was similar to that for PGC patients (p = 0.67). 2) Patients with RGC had a different pattern of lymph node metastasis compared with that in PGC. Particularly in advanced RGC with pT2–T4 tumors, RGC frequently demonstrated jejunal mesentery lymph node metastases (RGC vs. PGC, 35% vs. 0%) and splenic hilar lymph node metastases (RGC vs. PGC, 17% vs. 10%). The jejunal mesentery lymph node metastases were detected only following Billroth II reconstruction (Billroth I vs. Billroth II, 0% vs. 67%).


Although the clinical behaviors of the two gastric cancers were different, the survival rates were similar. The pattern of metastasis indicates that the jejunal mesentery and splenic hilar lymph nodes should be specifically targeted for en bloc resection during complete gastrectomy in RGC.

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  1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005; 55: 74–108.

    Article  PubMed  Google Scholar 

  2. Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer. 2007; 10:1–11.

    Article  PubMed  Google Scholar 

  3. Degiuli M, Sasako M, Ponti A; Italian Gastric Cancer Study Group. Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg. 2010; 97:643–649.

    Article  PubMed  CAS  Google Scholar 

  4. Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, et al. JCOG Gastric Cancer Surgical Study Group. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer. 2010; 13:238–244.

    Article  PubMed  Google Scholar 

  5. Sasako M, Maruyama K, Kinoshita T, Okabayashi K. Surgical treatment of carcinoma of the gastric stump. Br J Surg. 1991; 78:822–824.

    Article  PubMed  CAS  Google Scholar 

  6. Newman E, Brennan MF, Hochwald SN, Harrison LE, Jr. Karpeh MS. Gastric remnant carcinoma: just another proximal gastric cancer or a unique entity? Am J Surg 1997; 173:292–297.

    Article  PubMed  CAS  Google Scholar 

  7. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma, Fourteenth Edition. (in Japanese). Tokyo: Kanehara, 2010.

  8. Sobin L, Gospodarowicz M, Wittekind C, editors. International union against cancer. TNM classification of malignant tumours, Seventh Edition. New York: Wiley-Blackwell; 2010.

  9. Ohashi M, Katai H, Fukagawa T, et al. Cancer of the gastric stump following distal gastrectomy for cancer. Br J Surg 2007; 94:92–95.

    Article  PubMed  CAS  Google Scholar 

  10. Kaneko K, Kondo H, Saito D, Shirao K, Yamaguchi H, Yokota T, et al. Early gastric stump cancer following distal gastrectomy. Gut 1998; 43:342–344.

    Article  PubMed  CAS  Google Scholar 

  11. Kaminishi M, Shimizu N, Shiomoyama S, Yamaguchi H, Ogawa T, Sakai S, et al. Etiology of gastric remnant cancer with special reference to the effects of denervation of the gastric mucosa. Cancer 1995; 75:1490–1496.

    Article  PubMed  CAS  Google Scholar 

  12. Tersmette AC, Offerhaus GJ, Tersmette KW, Giardiello FM, Moore GW, Tytgat GN, et al. 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 1990; 50:6486–6489.

    PubMed  CAS  Google Scholar 

  13. Ahn HS, Kim JW, Yoo MW, Park do J, Lee HJ, Lee KU, et al. Clinicopathological features and surgical outcomes of patients with remnant gastric cancer after a distal gastrectomy. Ann Surg Oncol 2008; 15:1632–1639.

    Article  PubMed  Google Scholar 

  14. Tanigawa N, Nomura E, Lee SW, Kaminishi M, Sugiyama M, Aikou T, et al. Society for the Study of Postoperative Morbidity after Gastrectomy. Current state of gastric stump carcinoma in Japan: based on the results of a nationwide survey. World J Surg 2010; 34:1540–1547.

    Article  PubMed  Google Scholar 

  15. Kodera Y, Yamamura Y, Torii A, Uesaka K, Hirai T, Yasui K, et al. Gastric stump carcinoma after partial gastrectomy for benign gastric lesion: what is feasible as standard surgical treatment? J Surg Oncol 1996; 63:119–124.

    Article  PubMed  CAS  Google Scholar 

  16. Maruyama K, Kaminishi M, Hayashi K, Isobe Y, Honda I, Katai H, et al. Gastric cancer treated in 1991 in Japan: data analysis of nationwide registry. Gastric Cancer 2006; 9:51–66

    Article  PubMed  Google Scholar 

  17. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N. Japanese Laparoscopic Surgery Study Group. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 2007; 245:68–72.

    Article  PubMed  Google Scholar 

  18. Nakayoshi T, Tajiri H, Matsuda K, Kaise M, Ikegami M, Sasaki H. Magnifying endoscopy combined with narrow band imaging system for early gastric cancer: correlation of vascular pattern with histopathology (including video). Endoscopy 2004; 36:1080–1084.

    Article  PubMed  CAS  Google Scholar 

  19. Takenaka R, Kawahara Y, Okada H, Tsuzuki T, Yagi S, Kato J, et al. Endoscopic submucosal dissection for cancers of the remnant stomach after distal gastrectomy. Gastrointest Endosc 2008; 67:359–363.

    Article  PubMed  Google Scholar 

  20. Hirasaki S, Kanzaki H, Matsubara M, Fujita K, Matsumura S, Suzuki S. Treatment of gastric remnant cancer post distal gastrectomy by endoscopic submucosal dissection using an insulation-tipped diathermic knife. World J Gastroenterol 2008; 14:2550–2555.

    Article  PubMed  Google Scholar 

  21. An JY, Choi MG, Noh JH, Sohn TS, Kim S. The outcome of patients with remnant primary gastric cancer compared with those having upper one-third gastric cancer. Am J Surg 2007; 194:143–147.

    Article  PubMed  CAS  Google Scholar 

  22. Schaefer N, Sinning C, Standop J, Overhaus M, Hirner A, Wolff M. Treatment and prognosis of gastric stump carcinoma in comparison with primary proximal gastric cancer. Am J Surg 2007; 194:63–67

    Article  PubMed  Google Scholar 

  23. Han SL, Hua YW, Wang CH, Ji SQ, Zhuang J. Metastatic pattern of lymph node and surgery for gastric stump cancer. J Surg Oncol 2003; 82:241–246.

    Article  PubMed  Google Scholar 

  24. Kunisaki C, Shimada H, Nomura M, Hosaka N, Akiyama H, Ookubo K, et al. Lymph node dissection in surgical treatment for remnant stomach cancer. Hepatogastroenterology 2002; 49:580–584.

    PubMed  Google Scholar 

  25. Yonemura Y, Ninomiya I, Tsugawa K, Masumoto H, Takamura H, Fushida S, et al. Lymph node metastases from carcinoma of the gastric stump. Hepatogastroenterology 1994; 41:248–252.

    PubMed  CAS  Google Scholar 

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Correspondence to Shuhei Komatsu or Daisuke Ichikawa.

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Komatsu, S., Ichikawa, D., Okamoto, K. et al. Differences of the Lymphatic Distribution and Surgical Outcomes Between Remnant Gastric Cancers and Primary Proximal Gastric Cancers. J Gastrointest Surg 16, 503–508 (2012).

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