Clinicopathologic features of remnant gastric cancer after curative distal gastrectomy according to previous reconstruction method: a retrospective cohort study

Abstract

Background: Survival rate of patients treated for gastric cancer has increased due to early detection and improvements of surgical technique and chemotherapy. Increase in survival rate has led to an increase in the risk for remnant gastric cancer (RGC). The purpose of this study was to investigate clinicopathologic features of RGC according to previous reconstruction method and factors affecting the interval from previous curative distal gastrectomy for gastric cancer to RGC occurrence.

Methods: Medical records of patients diagnosed with RGC at Yeungnam University Medical Center from January 2000 to December 2017 who had a history of distal gastrectomy with D2 LN dissection due to gastric cancer were reviewed retrospectively.

Results: Forty-eight patients were enrolled in this study. The mean interval of 48 RGC patients was 105.6 months (8.8 years). RGC after Billroth II reconstruction recurred more often at anastomosis site than RGC after Billroth I reconstruction (p = 0.001). The mean interval of RGC after Billroth I reconstruction was 67 months, shorter than 119 months of RGC after Billroth II reconstruction (p = 0.003). On the contrary, interval showed no difference according to stage of previous gastric cancer, remnant gastric cancer, or sex (p = 0.810, 0.145, and 0.372, respectively).

Conclusions: RGC after Billroth I reconstruction tends to arise earlier at non-anastomosis site than RGC after Billroth II. Therefore, we should examine non-anastomosis site carefully from the beginning of surveillance after gastric cancer surgery with Billroth I reconstruction for better outcome.

Keywords: Reconstruction; Recurrence interval; Remnant gastric cancer.

Fig. 1

Patients selection flow chart. RGC, remnant gastric cancer; FUS, follow-up study; RGC-B I, RGC after Billroth I reconstruction; RGC-B II, RGC after Billroth II reconstruction

Fig. 2

Schematic figure of remnant stomach and the pattern of RGC according to previous reconstruction methods. Anastomosis sites are apart from suture line (transected line) (a), (c). Most (84.6%) of RGC-B I occurred at non-anastomosis site, especially cardia and PB or MB (b). Most (71.4%) of RGC-B II occurred at anastomosis site with long interval (130 months) (d). RGC, remnant gastric cancer; PB, proximal body; MB, mid-body; RGC-B I, RGC after Billroth I reconstruction; RGC-B II, RGC after Billroth II reconstruction

Fig. 3

Interval distribution of RGC according to diverse factors. Occurrence pattern and interval of RGC are affected by precancerous and environmental factors. These mechanisms of carcinogenesis are also affected by primary disease, previous reconstruction method, and size of remnant stomach. RGC, remnant gastric cancer; RGC-B, RGC after benign disease; RGC-M, RGC after gastric cancer; RGC-B I, RGC after Billroth I reconstruction; RGC-B II, RGC after Billroth II reconstruction