Recurrence of gastric cancer in the jejunal stump after radical total gastrectomy

Abstract

This is a very rare case of the recurrence of gastric cancer in the jejunal stump after radical total gastrectomy with Roux-en-Y reconstruction. In January 2008, a 65-year-old man underwent radical total gastrectomy with Roux-en-Y reconstruction for stage IB gastric cancer of the upper body. At a follow-up in December 2011, the patient had a recurrence of gastric cancer on gastroduodenal fibroscopy. The gastroduodenal fibroscopic biopsy specimens show a well-differentiated tubular adenocarcinoma. Computed tomography showed no lymphadenopathy or hepatic metastases. At laparotomy, there was a tumor in the jejunal stump involving the pancreatic tail and spleen. Therefore, the patient underwent jejunal pouch resection, distal pancreatectomy and splenectomy. The patient was diagnosed with gastric cancer on histopathological examination.

Clinical Outcomes of Recurrent Gastric Cancer Detected by Upper Endoscopy after Curative Total Gastrectomy

“…Masses and strictures, which are the more serious types of recurrence, were more frequent than ulcers or nodularities, which are usually early forms of cancer. Local recurrence after total gastrectomy usually occurs in the region proximal to the esophagojejunal junction (16). In our case, 15 (88.2%) of the tumors were in the anastomotic area or the proximal part of the jejunal loop and only 2 (11.8) were in the afferent loop stump.…”

“…Recurrence in the esophagojejunal anastomotic area after total gastrectomy can be explained by implantation of intraluminal tumor cells into the anastomosis (3). According to several reports, recurrence can occur in the jejunal stump due to spreading of cancer cells via submucosal or subserosal lymphatic vessels, or implantation of exfoliated cancer cells (16-17-18).…”