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Das magenstumpfkarzinom

Diagnose, operatives vorgehen und prognose

Gastric stump cancer

Diagnosis, operative procedure, and prognosis

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Abstract

The results of a retrospective analysis of cases of gastric stump cancer are reported. Among 298 gastric carcinomas treated between 1. 1. 1986 and 1. 3. 1994, we found 28 (9.5%) cases of gastric stump cancer. Gastric carcinoma showed a male preponderance, with a male: female ratio of ca. 4: 1. Two thirds of the patients were older than 70 years at the time of diagnosis. In 27 of 28 patients the original operation performed was a Billroth II resection without Braun's enteroanastomosis. The mean time lag before the development of gastric stump cancer was significantly shorter in the group of patients older than 45 years at the time of first operation (n=16) than in patients 45 years or younger (n=12, P=0.03). Endoscopy with biopsy and endosonography were highly reliable diagnostic instruments. The capability of CT for recognizing lymphatic metastasis is poor (42.1 % sensitivity). The main risk factors for the development of gastric stump cancer, according to our data, are male sex, Billroth 11 resection for first reconstruction, age over 45 years at first operation, and gastric ulcer as reason for the original gastric resection. The cost benefit ratio and timing of endoscopic screening of partially gastrectomized patients are discussed.

Zusammenfassung

Im Zeitraum vom 1. 1. 1986 bis 1. 3. 1994 wurden an der Klinik für Chirurgie der Medizinischen Universität zu Lübeck 298 Patienten mit einem Magenkarzinom operiert, davon hatten 28 (9,5%) ein Magenstumpfkarzinom. Männer (n=22) und Frauen (n=6) erkrankten im Verhältnis von ca. 4: 1. Über 2/3 der Patienten mit Magenstumpfkarzinom (MSC) waren bei Diagnosestellung über 70 Jahre alt. 27 von 28 Patienten wurden ursprünglich wegen benigner Ulzera nach Billroth II ohne Braun-Fußpunktanastomose operiert. Die mittlere Latenzzeit zwischen Erstoperation und MSC lag bei den Patienten, deren Primäroperation nach dem 45. Lebensjahr durchgeführt wurde (n=16), signifikant niedriger als bei Patienten mit Erstoperation bis zum 45. Lebensjahr (n=12, p=0,03). Diagnostika der Wahl sind Ösophagogastroduodenoskopie und Endosonographie. Die Wertigkeit der Computertomographie zur Erkennung der Infiltration benachbarter Organe ist eingeschränkt. Als Risikofaktoren ergeben sich aus dem eigenen Krankengut männliches Geschlecht, die Billroth-II-Resektion ohne Braun-Fußpunktanastomose, Alter bei Erstoperation über 45 Jahre und Ulcus ventriculi. Bei Kumulation von Risikofaktoren sollten — unter Berücksichtigung regionaler Unterschiede — gezielte Screening-Untersuchungen vorgenommen werden.

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Authors and Affiliations

  1. Klinik für Chirurgie, Medizinische Universität, Ratzeburger Allee 160, D-23538, Lübeck

    P. Kujath, C. Eckmann, R. Broll & A. Woltmann

  2. Chirurgische Klinik, Ruhr-Universität, Bochum, Marienhospital, Herne

    G. Hohlbach

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  1. P. Kujath
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  2. C. Eckmann
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  3. R. Broll
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  4. A. Woltmann
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  5. G. Hohlbach
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Kujath, P., Eckmann, C., Broll, R. et al. Das magenstumpfkarzinom. Langenbecks Arch Chir 380, 108–114 (1995). https://doi.org/10.1007/BF00186417

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  • DOI: https://doi.org/10.1007/BF00186417

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