Department of Surgery, College of Medicine, Seoul National University, Seoul, Korea.
ABSTRACT
PURPOSE: Despite the decreasing incidence of primary gastric cancer, the incidence of gastric cancer in the remnant stomach has been increasing. This study evaluated the clinicopathologic features and prognosis of gastric cancer in the remnant stomach.
METHODS AND MATERIALS: The clinicopathologic features and prognosis of 31 cases of gastric cancers in the remnant stomach were evaluated retrospectively. 19 patients among them underwent partial gastrectomy for benign gastroduodenal disease (Group I), while 12 patients for malignant disease (Group II) which were detected at least 5 years after initial surgery and the clinicopathologic features and survival curves of two groups were compared. The clinicopathologic features evaluated included age, sex, interval between operations, type of operation, location of tumor, tumor size, Borrmann type, depth of invasion, lymph node metastasis, distant metastasis, TNM stage, histologic differentiation and Lauren classification.
RESULTS: The median age was 59 years, 28 patients (90.3%) were male and median time interval between operations was 15 years. Group I gastric remnant cancers were detected late after initial gastrectomy and have a significant tendency toward lymph node metastasis. Resection was carried out in 25 patients (81.0%) in which 22 patient (71.0%) underwent resections with curative intent. The overall 5 year survival rate was 45.5% and no significant difference was observed between the survival curves for patients with group I and group II. Depth of invasion, lymph node metastasis, distant metastasis, tumor size and curability of operation have prognostic significance in univariate analysis and multivariate analysis performed with above 5 factors has revealed that depth of invasion is the only independent prognostic factor.
CONCLUSIONS: Both groups are similar in survival rate and clinicopathologic characteristics except time interval between operations and lymph node metastasis. Early detection by periodic endoscopic follow-up and radical resection is a reasonable policy as a treatment of gastric remnant cancer.
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