Cancer Development in the Gastric Stump after Partial Gastrectomy for Ulcer^;

Abstract

A QUESTION REPEATEDLY discussed in recent years, but still unanswered, is whether a partial gastrectomy can lead to development of cancer in the remaining part of the stomach. This problem has more than academic interest, as partial gastrectomy is now a commonly used therapeutic method for relatively benign diseases, such as gastric and duodenal ulcers. Several pathologic factors operating in the resected stomach may be conceived to promote development of cancer. The acid production is usually impaired or abolished, the emptying is altered, and the abnormal communication with the intestine may lead to regurgitation of alkaline fluid into the stomach. The anacid atrophic-hypertrophic gastritis resulting from these changes may be imagined to form the basis for the subsequent development of cancer. On the other hand, there is also the possibility that the "ulcer disease" per se, apart from any changes caused by the operation, might be a factor in cancer pathogenesis.9 12 A number of cases in which partial gastrectomy has been followed by gastric cancer have been reported during the last 30 years. Similarly a number of cases have been reported of cancer developing after gastroenterostomy. From the literature Freedman et al. in a recent publication3 collected in all 58 cases of cancer, 23 cases developing after partial gastrectomy, the others after gastroenterostomy for gastric or duodenal ulcer. Although suggestive, these reports cannot be taken as evidence of any causal rela-*

Gastric Stump Cancer: What Is the Risk?

“…In 1956, Helsingen and Hillestad [7] suggested that patients operated on for gastric ulcer developed cancer of the gastric stump more frequently than those operated on for duodenal ulcer. Since then, the greater risk of malignant transformation after resection of the stomach for gastric ulcer is often mentioned [36,39]; however, this finding has not been supported by other authors [1-3, 10, 35, 43].…”

“…This entity is defined as a primary carcinoma arising from the gastric remnant at least 5 years after surgery for benign peptic disease. A minimal latency of 5 years is included in the definition to avoid misdiagnosis [7].…”

Risk factors for complications during surgical treatment of remnant gastric cancer

“…Patients who have undergone a partial gastrectomy for any reason are considered at increased risk of malignant formation in the remnant gastric tissue, termed a remnant gastric cancer [1][2][3]. As a result of recently increased health screening in Korea and Japan, more than 50 % of newly diagnosed cases of gastric cancer are in an early stage [4,5].…”

Limited subtotal gastrectomy for early remnant gastric cancer

“…Many previous studies have demonstrated the clinical and histopathological features of RGC, and that distal gastrectomy appears to increase the risk of its development, especially at the anastomosis site and suture line [1][2][3][4][5][6][7]. Although there have been no guidelines for surgical treatment of RGC, it is usually detected at an advanced stage, and total gastrectomy (TG) has been accepted for a long time.…”