Gastric stump carcinoma after distal subtotal gastrectomy for early gastric cancer: experience of 541 patients with long-term follow-up

• Published in: The American journal of surgery Vol. 209; no. 6; pp. 1063 - 1068
• Main Authors: Morgagni, Paolo, M.D, Gardini, Andrea, M.D, Marrelli, Daniele, M.D, Vittimberga, Giovanni, M.D, Marchet, Alberto, M.D, de Manzoni, Giovanni, M.D, Di Cosmo, Maria Antonietta, M.D, Rossi, Gian Maria, M.D, Garcea, Domenico, M.D, Roviello, Franco, M.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2015; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Anastomosis, Roux-en-Y; Deaths; Distal subtotal gastrectomy; Early gastric cancer; Endoscopy; Female; Follow-Up Studies; Gastrectomy - methods; Gastric cancer; Gastric Stump; Gastric stump carcinoma; Gastroenterostomy - methods; Humans; Kaplan-Meier Estimate; Long-term follow-up; Lymphatic system; Male; Middle Aged; Multivariate analysis; Neoplasm Recurrence, Local - epidemiology; Proportional Hazards Models; Retrospective Studies; Risk; Stomach Neoplasms - epidemiology; Stomach Neoplasms - surgery; Studies; Surgery; Survival analysis; Treatment Outcome; Tumors; Gastric stump carcinoma; Long-term follow-up; Early gastric cancer; Distal subtotal gastrectomy
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2014.06.021

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. Patients 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.