Cancer of the gastric stump following operations for benign gastric or duodenal ulcers

Abstract

Twenty-seven patients who developed cancer of the stomach after undergoing gastric resection (GR), gastroenterostomy (GE), and vagotomy and pyloroplasty (VP) for benign gastric or duodenal ulcer are reported. The etiology and the pathogenesis of this type of cancer are discussed. Long-term exposure of the gastric mucosa to bile and duodenal and pancreatic secretion reflux seems to create a premalignant potential state. Symptoms and the diagnostic methods of radiologic series, cytology, and endoscopy are discussed. We suggest a curative operative approach and discuss the poor value of palliative procedures. We emphasize the necessity of determining the prognosis with exploratory laparotomy which establishes at the same time the certitude of the diagnosis.

Gastric Stump Cancer: What Is the Risk?

“…GSca frequently infiltrates the esophagus but rarely extends into the jejunum or the mouth of the anastomosis, except in far advanced tumors [1,8]. This illustrates the tendency of stomach cancers to propagate in the proximal direction.…”

“…Based on these case series, retrospective uncontrolled surveys, autopsy material, case-control and cohort studies, the prevalence of GSca varies considerably from 0.8 to 8.9% [1-3, 5, 8-18]. This wide variation in the estimated prevaSaegesser [1] Safatle-Ribeiro/Ribeiro/Reynolds lence can be explained by: the relatively small number of patients surveyed, the lack of appropriate control or comparison groups, incomplete follow-up, the surveillance technique used, geographic differences, the heterogeneity of surgical procedures and ulcer types in many of the studies [8,[19][20][21]. Japan is one country where an increased risk has not yet been proven [20].…”

“…In nearly every population studied, however, the frequency of carcinoma of the gastric stump is higher than the risk of gastric cancer in the general population, even though two thirds of the gastric surface has been removed [8] (tables 1, 2). Based on these case series, retrospective uncontrolled surveys, autopsy material, case-control and cohort studies, the prevalence of GSca varies considerably from 0.8 to 8.9% [1-3, 5, 8-18].…”

“…The most frequent symptoms are weight loss, early satiety, epigastric heaviness, esophageal symptoms, general weakness, fatigue, abdominal pain and dyspepsia [15,24,26]. Obstruction of the outlet and hemorrhage occur infrequently [8]. Special attention must be paid to the development of any new symptoms of dyspepsia.…”

“…Radiologic examination is limited by surgical distortion and does not permit mucosal biopsy [1,8,9,31]. In the course of endoscopy, multiple biopsy specimens should be performed, since neoplasia may be present in patients with a normal macroscopic appearance and is often multicentric [17,26,[28][29][30].…”