Surgery for gastric remnant carcinoma following Billroth II gastrectomy.
Between January 1983 and December 1995, 31 patients with gastric remnant carcinoma were operated on 6-45 years after a Billroth II resection for peptic ulcer disease. Total gastrectomy with Roux-en-Y reconstruction was performed in all cases. In 16 patients (52%) extended resection with removal of one or more adjacent organs was necessary for oncological reasons. In this elderly population with a high incidence of pre-operative risk factors (55%), most tumours were classified as stage III or IV (45%). Although total gastrectomy should be the surgical option of first choice for gastric remnant carcinoma, it resulted in high levels of post-operative mortality and morbidity (13% and 35%, respectively), especially in patients with stage III and IV tumours who underwent resection of an adjacent organ. Despite extended surgery, if necessary, the recurrence rate after 'curative' surgery is high (8/20 patients) and the cumulative disease-free 5-year survival rate was 48%. Detection of the tumour at an earlier stage not only limits the extent of resection and lowers the complication rate, but also improves survival.
Lissens
P
P
Department of Abdominal Surgery, University Hospital, Leuven, Belgium.
Filez
L
L
Aerts
R
R
D'Hoore
A
A
Van Cutsem
E
E
Ectors
N
N
Penninckx
F
F
Kerremans
R
R
D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010437:Peptic Ulcer / Q000601:surgery*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome