Progression of remnant gastric cancer is associated with duration of follow-up following distal gastrectomy.
OBJECTIVE
To re-evaluate the recent clinicopathological features of remnant gastric cancer (RGC) and to develop desirable surveillance programs.


METHODS
Between 1997 and 2008, 1149 patients underwent gastrectomy for gastric cancer at the Department of Digestive Surgery, Kyoto Prefectural University of Medicine, Japan. Of these, 33 patients underwent gastrectomy with lymphadenectomy for RGC. Regarding the initial gastric disease, there were 19 patients with benign disease and 14 patients with gastric cancer. The hospital records of these patients were reviewed retrospectively.


RESULTS
Concerning the initial gastric disease, the RGC group following gastric cancer had a shorter interval [P < 0.05; gastric cancer vs benign disease: 12 (2-22) vs 30 (4-51) years] and were more frequently reconstructed by Billroth-I procedure than those following benign lesions (P < 0.001). Regarding reconstruction, RGC following Billroth-II reconstruction showed a longer interval between surgical procedures [P < 0.001; Billroth-II vs Billroth-I: 32 (5-51) vs 12 (2-36) years] and tumors were more frequently associated with benign disease (P < 0.001) than those following Billroth-I reconstruction. In tumor location of RGC, after Billroth-I reconstruction, RGC occurred more frequently near the suture line and remnant gastric wall. After Billroth-II reconstruction, RGC occurred more frequently at the anastomotic site. The duration of follow-up was significantly associated with the stage of RGC (P < 0.05). Patients diagnosed with early stage RGC such as stage I-II tended to have been followed up almost every second year.


CONCLUSIONS
Meticulous follow-up examination and early detection of RGC might lead to a better prognosis. Based on the initial gastric disease and the procedure of reconstruction, an appropriate follow-up interval and programs might enable early detection of RGC.
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
Shuhei
S
Komatsu
Daisuke
D
Ichikawa
Kazuma
K
Okamoto
Daito
D
Ikoma
Masahiro
M
Tsujiura
Yukihisa
Y
Nishimura
Yasutoshi
Y
Murayama
Atsushi
A
Shiozaki
Hisashi
H
Ikoma
Yoshiaki
Y
Kuriu
Masayoshi
M
Nakanishi
Hitoshi
H
Fujiwara
Toshiya
T
Ochiai
Yukihito
Y
Kokuba
Eigo
E
Otsuji
D000368:Aged; D016009:Chi-Square Distribution; D018450:Disease Progression; D055088:Early Detection of Cancer; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000401:mortality; D018530:Gastric Stump / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007564:Japan; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome