Surgical therapy of gastric stump carcinoma--a retrospective analysis of 109 patients

Abstract

Background/aims: Although gastric stump carcinoma has been described as early as 1922, knowledge regarding best treatment is still insufficient. Therefore, we analyzed our results of the surgical therapy of gastric stump carcinoma.

Methodology: Between May 1968 and November 1996, 109 patients were operated upon because of gastric stump carcinoma, and the data of these cases were retrospectively analyzed. Survival rates were calculated with the Kaplan-Meier method (Log-rank-test; p < 0.05).

Results: A distal Billroth II gastrectomy was the most frequent type of prior operation in 95.4% of the patients. Resectability was 67% (n = 73), and in 64 cases total gastrectomy with systematic lymphadenectomy was performed. Overall post-operative morbidity and mortality were 33.9% and 13.8% respectively. These figures were significantly reduced to 13.8% and 2.8% in the last decade. The 5-year survival rate after radical resection was 40.7%, and prognosis was influenced by R-classification and tumor stage.

Conclusions: Improvements of surgical technique and intensive care management enable resections of gastric stump carcinoma with a low peri-operative morbidity and mortality. Total gastrectomy with systematic lymphadenectomy should be the goal of surgical therapy to obtain a curative resection. Long-term prognosis is similar to that of primary gastric carcinomas.