Gastric remnant cancer: A distinct entity or simply another proximal gastric cancer?
BACKGROUND
The purpose of this study was to compare outcomes following resection of gastric remnant (GRC) and conventional gastric cancer.


METHODS
Patients who underwent resection for gastric cancer in 8 academic institutions from 2000-2012 were evaluated to compare morbidity, mortality, and survival based on history of prior gastrectomy.


RESULTS
Of the 979 patients who underwent gastrectomy with curative-intent during the 12-year study period, 55 patients (5.8%) presented with GRC and 924 patients (94.4%) presented with conventional gastric cancer. Patients with GRC were slightly older (median 69 vs. 66 years). GRC was associated with higher rates of complication (56% vs. 41%, P = 0.028), longer operative times (301 vs. 237 min, P < 0.001), higher intraoperative blood loss (300 vs. 200 ml, P = 0.012), and greater need for blood transfusion (43% vs. 23%, P = 0.001). There were no significant differences in 30-day (3.6% vs. 4%) or 90-day mortality (9% vs. 8%) between the two groups. Overall survival rates were similar between GRC and conventional gastric cancer (5-year 20.3% vs. 38.6%, P = 0.446). Multivariate analysis revealed that history of gastrectomy was not predictive of survival while established predictors (older age, advanced T-stage, nodal involvement, blood transfusion, multivisceral resection, and any complication) were associated with poor survival.


CONCLUSIONS
Despite higher morbidity, prognosis after resection of gastric remnant cancer is similar to conventional gastric cancer.
Department of Surgery, Stanford University, Stanford Cancer Institute, Stanford, California.
Thuy B
TB
Tran
Department of Surgery, New York University, New York City, New York.
Ioannis
I
Hatzaras
Department of Surgery, Stanford University, Stanford Cancer Institute, Stanford, California.
David J
DJ
Worhunsky
Department of Surgery, New York University, New York City, New York.
Gerardo A
GA
Vitiello
Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Malcolm Hart
MH
Squires
Department of Surgery, Barnes Jewish Hospital and The Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri.
Linda X
LX
Jin
Department of Surgery, The Johns Hopkins University, Baltimore, Maryland.
Gaya
G
Spolverato
Department of Surgery, Wake Forest University, Winston-Salem, North Carolina.
Konstantinos I
KI
Votanopoulos
Department of Surgery, The Ohio State University, Columbus, Ohio.
Carl
C
Schmidt
Department of Surgery, University of Wisconsin, Madison, Wisconsin.
Sharon
S
Weber
Department of Surgery, The Ohio State University, Columbus, Ohio.
Mark
M
Bloomston
Department of Surgery, University of Wisconsin, Madison, Wisconsin.
Clifford S
CS
Cho
Department of Surgery, Wake Forest University, Winston-Salem, North Carolina.
Edward A
EA
Levine
Department of Surgery, Barnes Jewish Hospital and The Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri.
Ryan C
RC
Fields
Department of Surgery, The Johns Hopkins University, Baltimore, Maryland.
Timothy M
TM
Pawlik
Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Shishir K
SK
Maithel
Department of Surgery, Stanford University, Stanford Cancer Institute, Stanford, California.
Jeffrey A
JA
Norton
Department of Surgery, Stanford University, Stanford Cancer Institute, Stanford, California.
George A
GA
Poultsides
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005743:Gastrectomy; D018530:Gastric Stump / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000473:pathology / Q000601:surgery; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
gastrectomy; gastric cancer; gastric remnant; gastric stump