Risk of Carcinoma in the Gastric Remnant After Gastric Resection for Benign Conditions

Abstract

Up to 1950, carcinoma of the gastric remnant after resection for a benign lesion seemed to be a rare disease. Morgenstern et al. [25] estimated the number of patients with cancer of the gastric stump mentioned in the world literature up to the year 1972 to be about 1100. Kuhlmayer and Rokitansky [22] collected among 50000 autopsies at the Institute of Pathology of the University of Vienna, 363 cases with gastric resections type Billroth I, Billroth II, or gastroenterostomies and found 40 cancers in this material. This corresponds to an incidence of 11% compared to 5.3% gastric cancers in nonoperated stomachs among the 49637 other autopsies. Hilbe et al. [17] found in their necropsy material 5.4% cancers among nonoperated stomachs, but a frequency double as high in resected stomachs. Stalsberg and Taksdal [39] report that among 630 cases of gastric cancer, the frequency of previous gastric surgery for benign conditions, 25 years or more before death, was six times the frequency among matched controls. Even if one objects that necropsy material is biased by preselection in some way, one cannot deny the higher incidence of gastric stump cancer. There are few prospective studies based on endoscopically examined patients. From 1968 to 1974, Pesendorfer et al. [29] found 16% gastric stump cancers among their patients with resected stomachs. Schmid et al. [35] evaluated 24000 gastroscopies and found 609 patients with gastrojejunostomy, after an interval of at least 5 years after gastric resection, 39 of them had gastric stump cancer (6.4%).