Abstract
BackgroundThe incidence of remnant gastric cancer (RGC) after distal gastrectomy is 1–5%. However, as the survival rate of patients with gastric cancer improves due to early detection and treatment, more patients may develop RGC. There is no consensus on the surgical and postoperative management of RGC, and the clinicopathological characteristics correlated with the long-term outcomes remain unclear. Therefore, we investigated the clinicopathological factors associated with the long-term outcomes of RGC.MethodsWe included 65 consecutive patients who underwent gastrectomy for RGC from January 2000 to December 2015 at the Osaka Medical and Pharmaceutical University Hospital, Japan. The Kaplan–Meier method was used to create survival curves, and differences in survival were compared between the groups (clinical factors, pathological factors, and surgical factors) using the log-rank test. Multivariate analyses using the Cox proportional hazard model were used to identify factors associated with long-term survival.ResultsNo significant differences were noted in the survival rate based on clinical factors (age, body mass index, diabetes mellitus, hypertension, cardiovascular disease, pulmonary complications, liver disease, diet, history of alcohol drinking, and history of smoking) or the type of remnant gastrectomy. Significant differences were noted in the survival rate based on pathological factors and surgical characteristics (intraoperative blood loss, operation time, and the number of positive lymph nodes). Multivariate analysis revealed that the T stage (hazard ratio, 5.593; 95% confidence interval [CI], 1.183–26.452; p = 0.030) and venous invasion (hazard ratio, 3.351; 95% CI, 1.030–10.903; p = 0.045) were significant independent risk factors for long-term survival in patients who underwent radical resection for RGC.ConclusionsT stage and venous invasion are important prognostic factors of long-term survival after remnant gastrectomy for RGC and may be keys to managing and identifying therapeutic strategies for improving prognosis in RGC.
Highlights
The incidence of remnant gastric cancer (RGC) after distal gastrectomy is 1–5%
Multivariate analysis of prognostic factors Multivariate analysis revealed that the T stage and venous invasion were significant independent risk factors for the long-term survival of patients who underwent radical resection for RGC (Table 3)
Our findings showed that the pathological T stage and venous invasion were significant independent risk factors for survival among patients with RGC; the pathological N stage was not significantly associated with long-term survival
Summary
The incidence of remnant gastric cancer (RGC) after distal gastrectomy is 1–5%. as the sur‐ vival rate of patients with gastric cancer improves due to early detection and treatment, more patients may develop RGC. There is no consensus on the surgical and postoperative management of RGC, and the clinicopathological char‐ acteristics correlated with the long-term outcomes remain unclear. The number of patients with RGC who undergo gastrectomy for benign diseases has decreased due to improvements in treatment, more patients with a previous malignant disease are developing RGC because of improved prognosis after gastric cancer [5]. Some researchers have reported that the prognosis of advanced RGC is worse than that of primary advanced gastric cancer [9]. Despite these findings, there has been no consensus on the surgical and postoperative management for RGC, and the clinicopathological characteristics that are correlated with long-term outcomes remain unclear. We have investigated the clinicopathological factors associated with the long-term outcomes of RGC
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