title: Current status in remnant gastric cancer after distal gastrectomy.
abstract: Remnant gastric cancer (RGC) and gastric stump cancer after distal gastrectomy (DG) are recognized as the same clinical entity. In this review, the current knowledges as well as the non-settled issues of RGC are presented. Duodenogastric reflux and denervation of the gastric mucosa are considered as the two main factors responsible for the development of RGC after benign disease. On the other hand, some precancerous circumstances which already have existed at the time of initial surgery, such as atrophic gastritis and intestinal metaplasia, are the main factors associated with RGC after gastric cancer. Although eradication of Helicobacter pylori (H. pylori) in remnant stomach is promising, it is still uncertain whether it can reduce the risk of carcinogenesis. Periodic endoscopic surveillance after DG was reported useful in detecting RGC at an early stage, which offers a chance to undergo minimally invasive endoscopic treatment or laparoscopic surgery and leads to an improved prognosis in RGC patients. Future challenges may be expected to elucidate the benefit of eradication of H. pylori in the remnant stomach if it could reduce the risk for RGC, to build an optimal endoscopic surveillance strategy after DG by stratifying the risk for development of RGC, and to develop a specific staging system for RGC for the standardization of the treatment by prospecting the prognosis.
authors.affiliation: Masaichi Ohira, Takahiro Toyokawa, Katsunobu Sakurai, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Masakazu Yashiro, Naoyoshi Onoda, Kosei Hirakawa, Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan.
authors.forename: Masaichi
authors.initials: M
authors.lastname: Ohira
authors.affiliation: Masaichi Ohira, Takahiro Toyokawa, Katsunobu Sakurai, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Masakazu Yashiro, Naoyoshi Onoda, Kosei Hirakawa, Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Toyokawa
authors.affiliation: Masaichi Ohira, Takahiro Toyokawa, Katsunobu Sakurai, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Masakazu Yashiro, Naoyoshi Onoda, Kosei Hirakawa, Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan.
authors.forename: Katsunobu
authors.initials: K
authors.lastname: Sakurai
authors.affiliation: Masaichi Ohira, Takahiro Toyokawa, Katsunobu Sakurai, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Masakazu Yashiro, Naoyoshi Onoda, Kosei Hirakawa, Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan.
authors.forename: Naoshi
authors.initials: N
authors.lastname: Kubo
authors.affiliation: Masaichi Ohira, Takahiro Toyokawa, Katsunobu Sakurai, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Masakazu Yashiro, Naoyoshi Onoda, Kosei Hirakawa, Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Masaichi Ohira, Takahiro Toyokawa, Katsunobu Sakurai, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Masakazu Yashiro, Naoyoshi Onoda, Kosei Hirakawa, Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Muguruma
authors.affiliation: Masaichi Ohira, Takahiro Toyokawa, Katsunobu Sakurai, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Masakazu Yashiro, Naoyoshi Onoda, Kosei Hirakawa, Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yashiro
authors.affiliation: Masaichi Ohira, Takahiro Toyokawa, Katsunobu Sakurai, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Masakazu Yashiro, Naoyoshi Onoda, Kosei Hirakawa, Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan.
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Onoda
authors.affiliation: Masaichi Ohira, Takahiro Toyokawa, Katsunobu Sakurai, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Masakazu Yashiro, Naoyoshi Onoda, Kosei Hirakawa, Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan.
authors.forename: Kosei
authors.initials: K
authors.lastname: Hirakawa
mesh_terms: D000818:Animals; D004383:Duodenogastric Reflux / Q000209:etiology; D005743:Gastrectomy / Q000009:adverse effects*; D005753:Gastric Mucosa / Q000294:innervation / Q000473:pathology / Q000601:surgery*; D018530:Gastric Stump / Q000473:pathology* / Q000601:surgery; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D010535:Laparoscopy; D009367:Neoplasm Staging; D012086:Reoperation; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Endoscopic treatment; Helicobacter pylori; Laparoscopic surgery; Remnant gastric cancer; Surveillance