Early cancer of the gastric remnant with special reference to the importance of follow-up of gastrectomized patients

Abstract

Seven patients with early cancer of the gastric remnant (group 1) and nine with gastric remnant cancer that developed after surgery for early gastric cancer (group 2) were studied clinicopathologically. In group 1, the great majority of cases were classified as type I by gross type. Most lesions existed in the posterior wall of the remnant stomach. All lesions were differentiated carcinomas. In group 2, six of the nine early gastric tumors resected at the initial surgery were present in site A and three in site M. Gross tumours were of various types. Six patients underwent Billroth II resection and two underwent Billroth I resection. At second surgery (for gastric remnant cancer) four lesions were found to be located in the gastric stump or anastomosed region and five in the posterior wall of the stomach remnant. Histologically, the lesions included four undifferentiated carcinomas and five differentiated carcinomas. Of the nine lesions involving the gastric remnant, only two were early stage: the remaining seven were in an advanced stage. Prognosis was extremely poor in the group, many patients dying of carcinomatous peritonitis. In summary, most group 1 patients had a type I lesion in the remnant stomach. In group 2, more than half of the lesions were present in the gastric stump or anastomosed site and most were in an advanced stage. These observations suggest that it is very important to follow up patients operated on for early gastric cancer in order to detect malignant lesions, if any, in the remnant stomach before disease progresses to a stage at which radical resection is no longer possible. Follow-up will no doubt improve long-term results following surgery for early gastric cancer. We consider endoscopic examination and biopsy, especially of the gastric stump and anastomosed site, of great importance for gastrectomized patients.