Is subtotal gastrectomy feasible for the treatment of gastric stump cancer located at the anastomotic site after distal gastrectomy for benign lesions?

Fuhai Ma,Bingzhi Wang,Liyan Xue,Shuai Ma,Wenzhe Kang,Yingtai Chen,Hao Liu,Yang Li,Weikun Li,Yuxin Zhong,Yibin Xie,Yantao Tian

doi:10.1186/s12957-020-01821-y

Abstract

BackgroundTotal gastrectomy (TG) is a widely accepted procedure for treating gastric stump cancer (GSC). However, subtotal gastrectomy (SG) would benefit elective patients with GSC. The aim of this study was to clarify the safety and long-term prognosis of SG in treating GSC after distal gastrectomy for benign lesions.MethodsA total of 53 patients with GSC located at the anastomotic site or gastric body between May 1999 and December 2018 at our hospital were included. In total, 21 patients underwent SG, and the remaining 24 patients underwent TG. Clinicopathological data, operative data, and overall survival (OS) were compared.ResultsThe operative duration, estimated blood loss volume, and length of hospital stay were similar between the SG and TG groups. The postoperative complications were similar between the two groups, but no cases of anastomotic leakage were noted in the SG group. TG was associated with significantly more retrieved lymph nodes than SG (18.5 ± 11.5 vs. 10.7 ± 9.2; p = 0.017), while the number of metastatic lymph nodes did not differ between the groups (2.9 ± 3.5 vs. 1.9 ± 3.6; p = 0.329). The median survival time in the SG group was 81.0 months (95% confidence interval (CI), 68.906 to 93.094 months), which was similar to the 45.0 months (95% CI, 15.920 to 74.080 months) observed in the TG group (p = 0.236). Both univariate and multivariate analyses showed that tumor location and histological type were prognostic factors, while surgery type was not a prognostic factor. Further stratified analyses according to tumor location revealed that OS was not significantly different between the two groups among patients with tumors located at the anastomotic site, while OS in the TG group was significantly better than that in the SG group among patients with tumors located in the gastric body (p = 0.046).ConclusionsThe results of the current study indicate that SG is a suitable alternative surgical procedure for GSC located at the anastomotic site after distal gastrectomy for benign lesions. The short-term outcomes and long-term prognoses of SG are comparable with those of TG.

Highlights

Total gastrectomy (TG) is a widely accepted procedure for treating gastric stump cancer (GSC)
GSC is characteristically considered a separate clinical entity, defined as adenocarcinoma arising in the gastric stump more than 5 years following an initial gastrectomy for benign disease [6]
The mean time from the initial surgery to GSC diagnosis was comparable between the subtotal gastrectomy (SG) and TG groups (32.4 ± 7.4 vs. 31.7 ± 9.9 years; p = 0.788)

Summary

Introduction

Total gastrectomy (TG) is a widely accepted procedure for treating gastric stump cancer (GSC). Subtotal gastrectomy (SG) would benefit elective patients with GSC. The aim of this study was to clarify the safety and long-term prognosis of SG in treating GSC after distal gastrectomy for benign lesions. The incidence of gastric stump cancer (GSC) has been reported to represent 1–8% of all gastric cancer cases, and this number continues to increase [3,4,5]. GSC is characteristically considered a separate clinical entity, defined as adenocarcinoma arising in the gastric stump more than 5 years following an initial gastrectomy for benign disease [6]. The risk of GSC is closely linked to the interval after the initial gastrectomy [7]. GSC will continue to be encountered by surgeons [4, 8]

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