Gastric stump carcinoma as a long-term complication of pancreaticoduodenectomy: report of two cases and review of the English literature

Morgane Bouquot,Louise Barbier,Jérôme Cros,Safi Dokmak,Alain Sauvanet,Philippe Levy

doi:10.1186/s12876-017-0682-x

Morgane Bouquot, Louise Barbier + Show 4 more

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https://doi.org/10.1186/s12876-017-0682-x

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Abstract

BackgroundGastric stump carcinoma is an exceptional and poorly known long-term complication after pancreaticoduodenectomy.Cases presentationTwo patients developed gastric stump carcinoma 19 and 10 years after pancreaticoduodenectomy for malignant ampulloma and total pancreaticoduodenectomy for pancreatic adenocarcinoma, respectively. Both patients had pT4 signet-ring cell carcinoma involving the gastrojejunostomy site that was revealed by bleeding or obstruction. Patient 1 is alive and remains disease-free 36 months after completion gastrectomy. Patient 2 presented with peritoneal carcinomatosis and died after palliative surgery. We identified only 3 others cases in the English literature.ConclusionsProlonged biliary reflux might be the most important risk factor of gastric stump carcinoma following pancreaticoduodenectomy. Its incidence might increase in the future due to prolonged survival observed after pancreaticoduodenectomy for benign and premalignant lesions.

Highlights

Gastric stump carcinoma is an exceptional and poorly known long-term complication after pancreaticoduodenectomy.Cases presentation: Two patients developed gastric stump carcinoma 19 and 10 years after pancreaticoduodenectomy for malignant ampulloma and total pancreaticoduodenectomy for pancreatic adenocarcinoma, respectively
Its incidence might increase in the future due to prolonged survival observed after pancreaticoduodenectomy for benign and premalignant lesions
The two cases of gastric stump carcinoma (GSC) following PD we reported were similar to GSC following distal gastrectomy because: a) PD included distal gastrectomy and reconstruction with hepaticojejunostomy and gastrojejunostomy on the same jejunal loop, that is similar to the Billroth II reconstruction which is supposed to increase the risk of GSC after distal gastrectomy [3, 8]; b) delay of diagnosis of GSC was very long (19 and 10 years after PD respectively), far from the usual delay of ampulloma or pancreatic ductal adenocarcinoma (PDAC) recurrence after PD suggesting that GSC was a second cancer; c) both GSC involved the gastrojejunostomy site, a frequent finding in GSC following distal gastrectomy [8]; d) pathologically, both GSC were signet-ring cell carcinoma and clearly differed from ampullary and pancreatic carcinomas