Gastric stump carcinoma: frequency, treatment, complications and prognosis

Abstract

Gastric stump carcinoma develops in the gastric remnant after partial gastrectomy. While the frequency of gastric cancer is declining, the incidence of gastric stump carcinoma has remained stable due to the long latency period. As the surgical treatment of gastric ulcers by partial gastrectomy has become much less important, more and more gastric stump carcinomas develop after oncological resection. This study compared the surgical therapy of gastric stump carcinoma with the therapy of primary gastric cancer. From 2001 to 2014 a total of 24 patients were surgically treated for gastric stump carcinoma in the University Hospital of Heidelberg. In the same time 428 patients underwent resection due to primary gastric cancer. Both groups were analyzed and compared with a focus on preoperative therapy, intraoperative differences, complications and overall survival. Patients with gastric stump carcinoma were older at disease onset (68years vs. 62years, p= 0.003). Compared with primary gastric cancer, patients with gastric stump carcinoma were more often suspected of having lymph node (cN+) involvement (51.4 % vs. 41.7 %, p< 0.001) but neoadjuvant therapy was applied less often (48.7 % vs. 14.3 %, p< 0.01). For resection of gastric stump carcinoma, extended resections were more often necessary (54.5 % vs. 28.2 %, p< 0.001). There were no significant differences in mean overall survival between the two patient groups (64.4months vs. 45.8months, p= 0.34) CONCLUSION: Despite the differences described, the treatment of gastric stump carcinoma does not essentially differ from that of primary gastric cancer. Carcinomas of the gastric stump are more often locally advanced and in our opinion aneoadjuvant therapy should be applied analogue to gastric cancer even if evidence-based data on this point are limited.