A clinicopathological study of gastric stump carcinoma following proximal gastrectomy.
BACKGROUND
We aimed to clarify the frequency and clinicopathological characteristics of gastric stump carcinoma following proximal gastrectomy.


METHODS
Three-hundred and sixteen patients who had undergone curative proximal gastrectomy over a 21-year period from January 1984 through December 2004 were reviewed.


RESULTS
Gastric stump carcinoma was observed in 17 patients (5.4%). The time interval between the initial gastrectomy and the treatment of gastric stump cancer was within 5 years in 3 patients, within 5-10 years in 8, and after 10 years in 6. Treatment included endoscopic resection (n = 4), completion total gastrectomy of the remnant stomach (n = 11), pancreatoduodenectomy (n = 1), and nonsurgical resection (n = 1). Pathologically, 9 carcinomas were differentiated and 8 were undifferentiated. In a review of reconstruction methods associated with disease stage, stage I was found in 6 of the 7 patients with esophagogastrostomy or short-segment jejunal interposition. On the other hand, stage I was found in only 3, but stage II-IV was found in 7 of the 10 patients with reconstruction by double-tract or long-segment jejunal interposition; thus, the tumor was more likely to be detected at an advanced stage after long-segment interposition (P = 0.049).


CONCLUSIONS
Gastric stump carcinoma following proximal gastrectomy occurred at a high frequency of 5.4% of initial resections. It is necessary to select a reconstruction method that facilitates postoperative endoscopic examination, as well as to follow up the patients after proximal gastrectomy in the long term for the early detection and early treatment of gastric stump carcinoma.
Ohyama
Shigekazu
S
Department of Surgery, Cancer Institute Hospital of JFCR, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Tokunaga
Masanori
M
Hiki
Naoki
N
Fukunaga
Tetsu
T
Fujisaki
Junko
J
Seto
Yasuyuki
Y
Yamaguchi
Toshiharu
T
D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology* / Q000601:surgery; D005260:Female; D005743:Gastrectomy; D018530:Gastric Stump / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000473:pathology; D019651:Plastic Surgery Procedures / Q000379:methods*; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery