Gastric Stump Cancer: What Is the Risk?

Abstract

Patients who have undergone partial gastric resections are at an increased risk for the development of cancer in the gastric remnant. The overall risk increases over time and is higher in patients with an initial diagnosis of gastric rather than duodenal ulcer, in men and following partial gastrectomy with Billroth II reconstruction. The site of tumor growth is predominantly in the anastomotic area, but may occur anywhere in the stump. Enterogastric reflux, achlorhydria, bacteria overgrowth, and Helicobacter pylori appear to be the major factors involved in the etiopathogenesis of the gastric stump cancer. Surveillance of these patients with endoscopy and multiple biopsies may provide the means to diagnose tumors at an early stage, but the cost-benefit ratio of surveillance requires further study. Despite the magnitude of alterations in gastric stump mucosa, unfortunately, at this time we do not have good predictors of patients who will develop a cancer.

Feasibility of Delta-Shaped Anastomoses in Totally Laparoscopic Distal Gastrectomy

“…One of the major advantages of DS over RY anastomosis is that the normal duodenal passage of food is preserved, since DS anastomosis is a variation of BI anastomosis. Therefore, dumping complaints are avoided [13,26,27]. No long-term nutritional disadvantages were found in the DS anastomosis patients.…”

Does remnant gastric cancer really differ from primary gastric cancer? A systematic review of the literature by the Task Force of Japanese Gastric Cancer Association

“…Patients who have undergone a partial gastrectomy because of either malignant disease or benign disease are considered to be at an increased risk of carcinogenesis in the remnant stomach, which is known as remnant gastric cancer (RGC) [1][2][3]. The most frequently used definition is ''cancer in the remnant stomach after surgery for benign disease and those after surgery for gastric cancer found at least 5 years after the primary surgery.''…”

Risk of Upper Gastrointestinal Cancer after Bariatric Operations

“…4 While the prevalence of Billroth II operations appears higher in the reported cases of gastric stump carcinoma, it may only reflect its higher frequency compared to the Billroth I technique. In addition to time since initial surgery, suggested risk factors 5 include sex (female), age at operation (old), and underlying disease (gastric ulcer).…”

“…The influence of Helicobacter pylori (HP) in the genesis of gastric pouch carcinoma is currently unsettled. 4,7 The prevalence of HP after partial gastrectomy is <50% and might be influenced by duodenogastric reflux. 8 This bacterium has not been found to be specific in the patients presenting with dysplasia or adenocarcinoma of the gastric remnant, but in the endoscopic surveillance study after partial gastrectomy of Giuliani et al, 9 the prevalence of intestinal metaplasia was four times higher in HPpositive patients (19.6% vs 4.6%).…”

“…It could, however, suffer from prolonged contact with stagnant bile, shown experimentally to promote carcinogenesis. 4 Five cases of adenocarcinoma of the distal stomach have been reported after gastric bypass. [18][19][20][21][22] Cancer was diagnosed at an advanced stage in four of the cases, 4,5, 8 and 22 years after the procedure.…”