Higher incidence of gastric remnant cancer after proximal than distal gastrectomy.
OBJECTIVE
Proximal gastrectomy has been widely accepted as a standard operation for early stage gastric cancer located in the upper third of the stomach. Therefore, cancer of the distal gastric remnant is now increasing. The aims of this study were to clarify and compare the incidences of gastric remnant cancer after proximal and distal gastrectomy.


METHODS
Data on a consecutive series of 809 cases of gastrectomy performed for early gastric cancer from 1991 to 2003 in Shikoku Cancer Center were analyzed retrospectively with respect to the incidence of gastric remnant cancer.


RESULTS
We performed distal gastrectomy in 624 patients and proximal gastrectomy in 47 patients during the study period. After those operations, the gastric remnants of 457 cases and 33 cases, respectively, were surveyed periodically by endoscopic examination at our hospital. Among those surveyed cases, 10 patients (2.2%) and 3 patients (9.1%) were diagnosed as having gastric remnant cancer, respectively. The gastric remnant cancer-free survival after proximal gastrectomy was significantly lower than that after distal gastrectomy.


CONCLUSIONS
Because of the higher incidence of gastric remnant cancer after proximal gastrectomy, it is more important to survey the gastric remnant after proximal gastrectomy periodically by postoperative endoscopic examination.
Nozaki
Isao
I
Department of Surgery, Division of Gastroenterology National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan. isnozaki@shikoku-cc.go.jp
Kurita
Akira
A
Nasu
Junichirou
J
Kubo
Yoshirou
Y
Aogi
Kenjirou
K
Tanada
Minoru
M
Takashima
Shigemitsu
S
D005260:Female; D005743:Gastrectomy / Q000379:methods*; D018530:Gastric Stump; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000601:surgery*