title: Gastric stump carcinoma after distal subtotal gastrectomy for early gastric cancer: experience of 541 patients with long-term follow-up.
abstract: BACKGROUND
  Gastric stump carcinoma (GSC) has been studied after primary gastrectomy for benign disease but few studies have evaluated its correlation with gastric cancer.
  
  
  METHODS
  We assessed 541 patients submitted to subtotal gastrectomy for early gastric cancer at least 15 years ago.
  
  
  RESULTS
  GSC was diagnosed in 16 (2.9%) patients, giving a 4% cumulative risk of GSC 20 years after surgery. Diagnosis was made within 5 years of surgery in 10 patients and after 8 years in 6 cases. GSC occurred in 13/470 (2.8%) patients submitted to Billroth 2 reconstruction, 2/30 (6.7%) patients who underwent Billroth 1, and 1/41 (2.4%) patients after Roux-en-Y reconstruction. Significant risk factors observed for GSC were histologic type and sex. Other synchronous or metachronous extragastric tumors were registered in 56 (11.2%) patients.
  
  
  CONCLUSIONS
  The risk of GSC was low, even 20 years after subtotal gastrectomy for early gastric cancer. Lauren intestinal histotype and male sex were frequently associated with GSC. No correlation was observed between GSC and reconstruction technique or multifocality. Clinically speaking, GSC could be considered a subset of gastric cancer.
authors.affiliation: Department of General Surgery, Morgagni-Pierantoni Hospital, via Carlo Forlanini 34, 47121 Forlì, Italy. Electronic address: p.morgagni@ausl.fo.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Morgagni
authors.affiliation: Department of General Surgery, Morgagni-Pierantoni Hospital, via Carlo Forlanini 34, 47121 Forlì, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gardini
authors.affiliation: Surgical Oncology Unit, University of Siena, Via Banchi di Sotto 55, 53100 Siena, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Marrelli
authors.affiliation: Department of General Surgery, Morgagni-Pierantoni Hospital, via Carlo Forlanini 34, 47121 Forlì, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vittimberga
authors.affiliation: Second Surgical Clinic, Padua University, via 8 Febbraio 2, 35122 Padua, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Marchet
authors.affiliation: First Surgical Clinic, Verona University, via dell'Artigliere 19, 37129 Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Manzoni
authors.affiliation: First Surgical Clinic, Verona University, via dell'Artigliere 19, 37129 Verona, Italy.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Di Cosmo
authors.affiliation: Second Surgical Clinic, Padua University, via 8 Febbraio 2, 35122 Padua, Italy.
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Rossi
authors.affiliation: Department of General Surgery, Morgagni-Pierantoni Hospital, via Carlo Forlanini 34, 47121 Forlì, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Garcea
authors.affiliation: Surgical Oncology Unit, University of Siena, Via Banchi di Sotto 55, 53100 Siena, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Roviello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D018530:Gastric Stump; D005763:Gastroenterostomy / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Distal subtotal gastrectomy; Early gastric cancer; Gastric stump carcinoma; Long-term follow-up