title: Surgical treatment of non-early gastric remnant carcinoma developing after distal gastrectomy for gastric cancer.
abstract: OBJECTIVE
  The optimal surgical procedure for gastric remnant carcinoma (GRC) remains debatable. The aim of this study was to retrospectively evaluate the surgical treatments for T2-4 GRC developing after distal gastrectomy for gastric cancer.
  
  
  METHODS
  Between 1970 and 2012, a total of 50 patients underwent R0 resection for T2-4 GRC. The clinicopathologic features, therapeutic methods, and follow-up data of these patients were reviewed.
  
  
  RESULTS
  The tumor was located at a non-anastomotic site of the remnant stomach in 43 of the 50 patients. Total gastrectomy was performed in 48 patients and partial gastrectomy was in two patients. Lymph node metastasis was found in 19 patients. Major postoperative complications occurred in 16 patients. The overall 1-, 3-, and 5-year survival rates of the 50 patients were 90%, 66%, and 44%, respectively. Presence of small intestinal or esophageal infiltration and postoperative complications was independently associated with poorer survival. Dissection of the perigastric and splenic hilar/artery nodes was found to have potential therapeutic benefit.
  
  
  CONCLUSIONS
  Surgical resection for T2-4 GRC developing after distal gastrectomy for gastric cancer can be invasive, but is feasible and effective. Total gastrectomy with splenectomy is one of the recommendable procedures for this disease.
authors.affiliation: Gastric Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ohashi
authors.forename: Shinji
authors.initials: S
authors.lastname: Morita
authors.forename: Takeo
authors.initials: T
authors.lastname: Fukagawa
authors.forename: Ryoji
authors.initials: R
authors.lastname: Kushima
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Katai
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004947:Esophagus / Q000473:pathology; D005260:Female; D005743:Gastrectomy; D018530:Gastric Stump / Q000601:surgery*; D006801:Humans; D007421:Intestine, Small / Q000473:pathology; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D011183:Postoperative Complications; D012189:Retrospective Studies; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: gastrectomy; outcome; remnant gastric cancer; splenectomy; surgical treatment