IDDF2019-ABS-0286 Differences in presentation of primary vs stump gastric carcinomas: short term analysis

Abstract

Background With the advent of effective medical treatment- PPI and H. pylori eradication, surgeries for Peptic Ulcer Disease (PUD) have drastically declined. Patients who underwent such surgeries a few decades earlier are still encountered in clinical practice, either benign or malignant. Presentation varies with the type of previous surgery done. Gastric Stump Carcinoma (GSC)- Increased risk of malignancy after gastrectomy, Carcinoma of the gastric remnant or the stump after partial gastrectomy with risk increasing 15 years after gastrectomy. Previous studies have demonstrated that rates of gastric stump carcinoma are consistently higher after treatment with a Billroth II procedure >> Billroth I procedure Aim To analyze whether any difference exists between presentation and management of primary gastric carcinoma and stump carcinoma Methods Retrospective study patients are divided into 2 groups I- Patients with GSC following truncal vagotomy and gastrojejunostomy for PUD II-Patients without previous gastric surgery with primary gastric carcinoma Clinico-pathological parameters of these groups were compared and analyzed Inclusion criteria - All patients with Resectable gastric and stump carcinomas in previous TV+GJ and good performance status Results Stomal malignancies presented with GI bleed in all cases(100%), followed by weight loss (75%) and vomiting (25%).Non-stomal malignancies presented with anorexia (83.3%), GI bleed (75%) and weight loss (75%). Total gastrectomy done in 1 stomal & 7 non-stomal malignancies. Subtotal gastrectomy done in 3 stomal and 5 non stomal malignancies. 3 in T3 and 1 in T1 stage in stomal group, 2 in NO and N1 stage each. In non stomal group T4 (n=7),N1 (n=7) and N2 (n=5) presentation. Conclusions High suspicion for malignancy and low threshold for endoscopy in patients with previous gastrojejunostomy -provide an opportunity for early diagnosis and curative resection in stump carcinomas Altered lymph flow and anatomic relationship with adjacent organs due to initial surgery. Surgical resection is considered an effective therapeutic strategy for GSC. Invasive extent and surgical curability of GSC-Prognosis of patients GSC have decreased rate of curative resection and long-term survival rate if identified at an advanced stage due to unapparent symptom and High incidence of lymph node metastasis