Tumors arising at previous anastomotic site may have poor prognosis in patients with gastric stump cancer following gastrectomy

Abstract

Introduction: We analyzed the clinicopathological characteristics and outcomes of patients with gastric stump cancer (GSC) to identify important prognostic factors.

Patients and methods: We retrospectively reviewed clinical reports of 34 patients with GSC treated at Kochi Medical School from 1982 to 2008 to analyze the clinical and pathological factors that influenced patient survival.

Results: The median interval between initial and second operation was 15.8 years; this interval was significantly longer in patients diagnosed originally with benign disease than in those with previous malignant disease. Histologically, the incidence of diffuse-type cancer was significantly prominent in patients with previous benign gastric disease than in those with previous malignant gastric disease. The overall 5-year survival rate was 53.3%, with presence of lymph node metastasis and pathological serosal invasion of the tumor associated with poor survival. The final analysis revealed tumor located at anastomosis, tumor size greater than 5 cm, serosal invasion, the presence of lymph node metastasis, and stage III or higher to be significantly associated with poor survival.

Conclusions: Follow-up programs after gastrectomy should account for long latency periods of disease. Early detection, attentive observation of anastomotic site, and sufficient surgical resection were important influences on outcome for patients with GSC after Billroth I or Billroth II reconstruction.