Advertisement

Annals of Surgical Oncology

, Volume 18, Issue 3, pp 670–676 | Cite as

Treatment and Outcome of Patients with Gastric Remnant Cancer After Resection for Peptic Ulcer Disease

  • James J. Mezhir
  • Mithat Gonen
  • John B. Ammori
  • Vivian E. Strong
  • Murray F. Brennan
  • Daniel G. Coit
Gastrointestinal Oncology

Abstract

Background

To study the pathology, treatment, and outcome of patients with gastric remnant cancer (GRC) after resection for peptic ulcer disease (PUD).

Methods

Review of a prospective gastric cancer database identified patients with GRC after gastrectomy for PUD. Clinicopathologic and treatment-related variables were obtained. Multivariate analysis was performed for factors associated with disease-specific survival (DSS).

Results

From January 1985 to April 2010, 4402 patients with gastric adenocarcinoma were treated at our institution and 105 patients (2.4%) had prior gastrectomy for PUD. Prior resections were most often Billroth II (N = 97, 92%). The median time from initial resection to development of GRC was 32 years (3–60 years), and the majority of tumors were located at the gastrointestinal anastomosis (N = 72, 69%). Median DSS was 1.3 years (0.6–2.1 years). Patients who had resection had a significantly better outcome than patients who did not have resection (median DSS 5 vs 0.35 years, P < .0001). Factors associated with DSS on multivariate analysis included advanced T-stage (HR 16.5 (CI 2.2–123.4), P = .0006) and lymph node metastasis (HR 1.1 (CI 1.0–1.2), P < .0001). Stage-specific survival following R0 resection was similar to patients with conventional gastric cancer.

Conclusions

Patients have a lifetime risk for the development of GRC following resection for PUD. As with conventional gastric cancer, determinants of survival of patients with GRC include advanced T stage and nodal metastasis. Patients with GRC amenable to curative resection exhibit the best DSS and have stage-specific outcomes similar to patients with conventional gastric cancer.

Keywords

Peptic Ulcer Disease Gastric Resection Gastric Remnant Gastric Remnant Cancer Duodenogastric Reflux 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Balfour DC. Factors influencing the life expectancy of patients operated on for gastric ulcer. Ann Surg. 1922;76:405–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Firat O, Guler A, Sozbilen M, Ersin S, Kaplan H. Gastric remnant cancer: an old problem with novel concerns. Langenbecks Arch Surg. 2009;394:93–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Fisher SG, Davis F, Nelson R, Weber L, Goldberg J, Haenszel W. A cohort study of stomach cancer risk in men after gastric surgery for benign disease. J Natl Cancer Inst. 1993;85:1303–10.PubMedCrossRefGoogle Scholar
  4. 4.
    Kodera Y, Yamamura Y, Torii A, Uesaka K, Hirai T, Yasui K, et al. Gastric remnant carcinoma after partial gastrectomy for benign and malignant gastric lesions. J Am Coll Surg. 1996;182:1–6.PubMedGoogle Scholar
  5. 5.
    Newman E, Brennan MF, Hochwald SN, Harrison LE, Karpeh MS Jr. Gastric remnant carcinoma: just another proximal gastric cancer or a unique entity? Am J Surg. 1997;173:292–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Sasako M, Maruyama K, Kinoshita T, Okabayashi K. Surgical treatment of carcinoma of the gastric stump. Br J Surg. 1991;78:822–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Sinning C, Schaefer N, Standop J, Hirner A, Wolff M. Gastric stump carcinoma - epidemiology and current concepts in pathogenesis and treatment. Eur J Surg Oncol. 2007;33:133–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Stael von Holstein CC, Anderson H, Eriksson SB, Huldt, B. (1995) Mortality after remote surgery for benign gastroduodenal disease. Gut 37:617–22.PubMedCrossRefGoogle Scholar
  9. 9.
    Toftgaard C. Gastric cancer after peptic ulcer surgery. A historic prospective cohort investigation. Ann Surg. 1989;210:159–64.PubMedCrossRefGoogle Scholar
  10. 10.
    Viste A, Bjornestad E, Opheim P, Skarstein A, Thunold J, Hartveit F, et al. Risk of carcinoma following gastric operations for benign disease. A historical cohort study of 3470 patients. Lancet. 1986; 2:502–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Kondo K. Duodenogastric reflux and gastric stump carcinoma. Gastric Cancer. 2002;5:16–22.PubMedCrossRefGoogle Scholar
  12. 12.
    Kondo K, Kojima H, Akiyama S, Ito K, Takagi H. Pathogenesis of adenocarcinoma induced by gastrojejunostomy in Wistar rats: role of duodenogastric reflux. Carcinogenesis. 1995;16:1747–51.PubMedCrossRefGoogle Scholar
  13. 13.
    Mason RC, Taylor PR, Filipe MI, McColl I. Pancreaticoduodenal secretions and the genesis of gastric stump carcinoma in the rat. Gut. 1988;29:830–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Greene FL. Management of gastric remnant carcinoma based on the results of a 15-year endoscopic screening program. Ann Surg. 1996;223:701–6; discussion 706–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Safatle-Ribeiro AV, Ribeiro U, Jr., Reynolds JC. Gastric stump cancer: what is the risk? Dig Dis. 1998;16:159–68.PubMedCrossRefGoogle Scholar
  16. 16.
    Thorban S, Bottcher K, Etter M, Roder JD, Busch R, Siewert JR. Prognostic factors in gastric stump carcinoma. Ann Surg. 2000;231:188–94.PubMedCrossRefGoogle Scholar
  17. 17.
    American Joint Committee on Cancer Staging Manual. 7th ed. Chicago, IL: Springer; 2010.Google Scholar
  18. 18.
    Han SL, Hua YW, Wang CH, Ji SQ, Zhuang J. Metastatic pattern of lymph node and surgery for gastric stump cancer. J Surg Oncol. 2003;82:241–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Hu X, Tian DY, Cao L, Yu Y. Progression and prognosis of gastric stump cancer. J Surg Oncol. 2009;100:472–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Schaefer N, Sinning C, Standop J, Overhaus M, Hirner A, Wolff M. Treatment and prognosis of gastric stump carcinoma in comparison with primary proximal gastric cancer. Am J Surg. 2007;194:63–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Martin RC, 2nd, Jaques DP, Brennan MF, Karpeh M. Extended local resection for advanced gastric cancer: increased survival versus increased morbidity. Ann Surg. 2002;236:159–65.PubMedCrossRefGoogle Scholar
  22. 22.
    Ikeguchi M, Kondou A, Shibata S, Yamashiro H, Tsujitani S, Maeta M, et al. Clinicopathologic differences between carcinoma in the gastric remnant stump after distal partial gastrectomy for benign gastroduodenal lesions and primary carcinoma in the upper third of the stomach. Cancer. 1994;73:15–21.PubMedCrossRefGoogle Scholar
  23. 23.
    Ohashi M, Katai H, Fukagawa T, Gotada T, Sano T, Sasako M. Cancer of the gastric stump following distal gastrectomy for cancer. Br J Surg. 2007;94:92–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Fukase K, Kato M, Kikuchi S, Inoue K, Uemura N, Okamoto S, et al. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet. 2008;372:392–7.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • James J. Mezhir
    • 1
  • Mithat Gonen
    • 2
  • John B. Ammori
    • 1
  • Vivian E. Strong
    • 1
  • Murray F. Brennan
    • 1
  • Daniel G. Coit
    • 1
  1. 1.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Epidemiology and BiostatisticsMemorial Sloan-Kettering Cancer CenterNew YorkUSA

Personalised recommendations