[Gastric stump carcinoma: frequency, treatment, complications and prognosis].
BACKGROUND
Gastric stump carcinoma develops in the gastric remnant after partial gastrectomy. While the frequency of gastric cancer is declining, the incidence of gastric stump carcinoma has remained stable due to the long latency period. As the surgical treatment of gastric ulcers by partial gastrectomy has become much less important, more and more gastric stump carcinomas develop after oncological resection.


OBJECTIVE
This study compared the surgical therapy of gastric stump carcinoma with the therapy of primary gastric cancer.


METHODS
From 2001 to 2014 a total of 24 patients were surgically treated for gastric stump carcinoma in the University Hospital of Heidelberg. In the same time 428 patients underwent resection due to primary gastric cancer. Both groups were analyzed and compared with a focus on preoperative therapy, intraoperative differences, complications and overall survival.


RESULTS
Patients with gastric stump carcinoma were older at disease onset (68 years vs. 62 years, p = 0.003). Compared with primary gastric cancer, patients with gastric stump carcinoma were more often suspected of having lymph node (cN+) involvement (51.4 % vs. 41.7 %, p < 0.001) but neoadjuvant therapy was applied less often (48.7 % vs. 14.3 %, p < 0.01). For resection of gastric stump carcinoma, extended resections were more often necessary (54.5 % vs. 28.2 %, p < 0.001). There were no significant differences in mean overall survival between the two patient groups (64.4 months vs. 45.8 months, p = 0.34) CONCLUSION: Despite the differences described, the treatment of gastric stump carcinoma does not essentially differ from that of primary gastric cancer. Carcinomas of the gastric stump are more often locally advanced and in our opinion a neoadjuvant therapy should be applied analogue to gastric cancer even if evidence-based data on this point are limited.
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland.
H
H
Nienhüser
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland.
S
S
Blank
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland.
L
L
Sisic
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland.
R
R
Kunzmann
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland.
U
U
Heger
Abteilung für Allgemein-, Vaskulär und Thoraxchirurgie, RoMed Klinikum Rosenheim, 83022, Rosenheim, Deutschland.
K
K
Ott
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland.
M W
MW
Büchler
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland.
T
T
Schmidt
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69117, Heidelberg, Deutschland. alexis.ulrich@med.uni-heidelberg.de.
A
A
Ulrich
D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005743:Gastrectomy; D018530:Gastric Stump / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate
Gastric cancer; Gastric remnant cancer; Gastrointestinal tumours; Partial gastrectomy; Surgical oncology
Surgery. 2016 Apr;159(4):1082-9
26497772
Anticancer Res. 1998 Jan-Feb;18(1A):231-5
9568082
Hepatogastroenterology. 2004 Sep-Oct;51(59):1515-8
15362790
West J Med. 1987 Sep;147(3):301-8
3314155
Gastric Cancer. 2002;5(1):16-22
12021855
J Surg Oncol. 2015 Feb;111(2):208-12
25175816
Lancet. 1986 Apr 26;1(8487):929-31
2871238
Eur J Gastroenterol Hepatol. 1997 Jan;9(1):33-40
9031896
Gastroenterology. 2007 Jun;132(7):2320-7
17570207
Eur J Surg Oncol. 2006 Dec;32(10):1191-4
16797159
Postgrad Med J. 2005 Jul;81(957):419-24
15998815
World J Gastroenterol. 2012 Jun 14;18(22):2832-6
22719193
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S905-14
26001861
Lancet. 1981 Jun 13;1(8233):1307-8
6112617
Ann Surg Oncol. 2011 Mar;18(3):670-6
21063791
Ann Surg. 1922 Sep;76(3):405-8
17864703
Hepatogastroenterology. 1994 Apr;41(2):130-3
8056399
Hepatogastroenterology. 1998 Sep-Oct;45(23):1896-900
9840172
N Engl J Med. 1988 Jul 28;319(4):195-200
3393171
Carcinogenesis. 1995 Aug;16(8):1747-51
7634399
World J Gastroenterol. 2014 Oct 14;20(38):13734-40
25320511
J Surg Oncol. 2015 Dec;112(8):877-82
26511335
Br J Surg. 2007 Jan;94(1):92-5
17054314
Am J Surg. 1997 Apr;173(4):292-7
9136783
Hepatogastroenterology. 2002 Mar-Apr;49(44):580-4
11995502
Cancer. 1995 Mar 15;75(6 Suppl):1490-6
7889480
Ann Surg Oncol. 2008 Jun;15(6):1632-9
18379851
Am J Surg. 2015 Jun;209(6):1063-8
25218580
J Clin Gastroenterol. 1996 Dec;23(4):251-5
8957725
World J Surg. 2010 Jul;34(7):1540-7
20182716
Br J Surg. 1991 Jul;78(7):822-4
1873711
J Gastrointest Surg. 2010 Feb;14(2):277-81
19911236
Int J Cancer. 2012 Sep 15;131(6):E1048-52
22532306
Aliment Pharmacol Ther. 1995;9 Suppl 2:3-12
8547525
Ann Surg. 2000 Feb;231(2):188-94
10674609
Ann Surg Oncol. 2014 Aug;21(8):2594-600
24639193
Am J Surg. 2007 Jul;194(1):63-7
17560911
Cancer Prev Res (Phila). 2011 Sep;4(9):1426-35
21680705
Am J Clin Oncol. 2013 Jun;36(3):244-9
22495457