Treatment and outcome of patients with gastric remnant cancer after resection for peptic ulcer disease.
BACKGROUND
To study the pathology, treatment, and outcome of patients with gastric remnant cancer (GRC) after resection for peptic ulcer disease (PUD).


METHODS
Review of a prospective gastric cancer database identified patients with GRC after gastrectomy for PUD. Clinicopathologic and treatment-related variables were obtained. Multivariate analysis was performed for factors associated with disease-specific survival (DSS).


RESULTS
From January 1985 to April 2010, 4402 patients with gastric adenocarcinoma were treated at our institution and 105 patients (2.4%) had prior gastrectomy for PUD. Prior resections were most often Billroth II (N = 97, 92%). The median time from initial resection to development of GRC was 32 years (3-60 years), and the majority of tumors were located at the gastrointestinal anastomosis (N = 72, 69%). Median DSS was 1.3 years (0.6-2.1 years). Patients who had resection had a significantly better outcome than patients who did not have resection (median DSS 5 vs 0.35 years, P < .0001). Factors associated with DSS on multivariate analysis included advanced T-stage (HR 16.5 (CI 2.2-123.4), P = .0006) and lymph node metastasis (HR 1.1 (CI 1.0-1.2), P < .0001). Stage-specific survival following R0 resection was similar to patients with conventional gastric cancer.


CONCLUSIONS
Patients have a lifetime risk for the development of GRC following resection for PUD. As with conventional gastric cancer, determinants of survival of patients with GRC include advanced T stage and nodal metastasis. Patients with GRC amenable to curative resection exhibit the best DSS and have stage-specific outcomes similar to patients with conventional gastric cancer.
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
James J
JJ
Mezhir
Mithat
M
Gonen
John B
JB
Ammori
Vivian E
VE
Strong
Murray F
MF
Brennan
Daniel G
DG
Coit
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy; D018530:Gastric Stump / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000401:mortality / Q000601:surgery*; D010437:Peptic Ulcer / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome