Gastric Stump Carcinoma Research Articles

Multiple early gastric stump carcinomas after gastrectomy for peptic ulcer

Multiple early gastric stump carcinomas after gastrectomy for peptic ulcer

Helicobacter pylori (HP) infection in gastric stump carcinoma

Helicobacter pylori (HP) infection in gastric stump carcinoma

Gastric stump carcinoma after partial gastrectomy for benign gastric lesion: What is feasible as standard surgical treatment?

Gastric stump carcinoma after partial gastrectomy for benign gastric lesion: What is feasible as standard surgical treatment?

Gastric stump carcinoma after partial gastrectomy for benign gastric lesion: what is feasible as standard surgical treatment?

Clinicopathological features and prognostic factors were evaluated in 26 cases of stump carcinoma, operated on in the recent 20 years, in search of the standard surgical treatment. Stump carcinoma usually emerges more than 20 years after the initial gastrectomy and is often not diagnosed in the early clinical stage, resulting in a significantly low incidence of curative resection compared with primary gastric carcinoma. No improvement in the survival curves for stump carcinoma was observed between the past two decades. Nodal metastases were frequently found within the first tier nodes, and no 5-year survivor was found among the patients with nodal metastasis beyond pN1. Subtotal gastrectomy might suffice for the treatment of stomal cancer, and most patients might not benefit from extensive lymphadenectomy.

Positive association between dietary fat intake and risk of gastric stump carcinoma in rats.

Effect of high- and low-fat diets on gastric stump carcinogenesis was experimentally investigated. A total of 130 Wistar male rats weighing 250-300 g received either sham operation or Billroth II partial gastrectomy, the resection of the distal two-thirds glandular stomach and reconstruction of gastro-jejunostomy. After surgery, each group of rats was switched from a standard diet (CRF-1) to a special diet containing either 15% soybean oil (high-fat) or 0.5% soybean (low-fat), fed ad libitum and tap water, and were killed 50 weeks after surgery. Gastric tumours were observed only in the animals that underwent gastrectomy while no tumours were detected in the animals following the sham operation. Tumours located invariably at the gastrojejunostoma, were carcinomas or adenomas in histology. Carcinomas developed in 12 of 29 gastrectomy animals (41%) fed the high-fat diet and 4 of 27 gastrectomy animals (15%) fed the low-fat diet. The difference was significant (P < 0.05). The incidence of adenoma was also significantly higher in the gastrectomy animals fed the high-fat diet (38%) than that in those fed the low-fat diet (15%) (P < 0.05). A daily faecal output of bile acids was significantly greater in the gastrectomy animals fed the high-fat diet (19.0 +/- 16.4 micromol/day) than that in those fed the low-fat diet (11.2 +/- 6.2 [micromol/day; P < 0.05). This study suggests that increased fat intake is associated with a high risk of gastric stump carcinoma.

Alterations in DNA proliferation in gastric stump mucosa with special reference to topography

Gastric stump carcinoma occurs more frequently at the anastomotic site than at other areas of the gastric remnant. This study was conducted to determine whether alterations in cell dynamics could be detected in the normal-looking gastric remnant mucosa and to ascertain any difference in cell dynamics between the anastomotic site and other area. Sixty-three patients who underwent curative subtotal gastrectomy for gastric adenocarcinoma were examined 8 to 130 months after operation. Mucosa at the anastomotic site and at the greater curvature were endoscopically biopsied. Cell dynamic changes were examined by flow cytometry, bromodeoxyuridine in vitro labeling, and oncogene (K-ras and c-myc) amplification and translocation by Southern blot analyses. Inflammatory changes were observed in more than 60% of the cases both at the anastomotic site and at the greater curvature both macroscopically and microscopically. Blood flow, measured by laser Doppler flowmeter, was significantly decreased at the anastomotic site compared with the greater curvature (25.0 +/- 8.1 and 32.2 +/- 9.4 mg/min/100 mg tissue, respectively; p < 0.05). Analysis of DNA histograms obtained by flow cytometry revealed a small peak at the right shoulder of 2N peak in 33% of the specimens obtained from the anastomosis site and in 15% of those from the greater curvature (p < 0.05). The number of cells at S phase measured by bromodeoxyuridine in vitro labeling was also significantly greater at the anastomotic site than at the greater curvature. None of the five patients with aneuploid DNA histograms at the anastomotic site had detectable amplification or translocation of K-ras or c-myc gene in mucosal tissue. More marked changes in the mucosal cell dynamics observed at the anastomotic site may partially explain the higher incidence of gastric stump carcinoma at the anastomotic site.

Linitis Plastica Presenting as Pouch Outlet Stenosis 13 Years after Vertical Banded Gastroplasty.

A 53-year-old woman, 13 years after vertical banded gastroplasty (VBG), presented with recently increased vomiting and high-grade pouch outlet stenosis, and was confirmed at laparotomy to have linitis plastics, for which she underwent total gastrectomy. Her pathology is unfavorable. Question is raised as to the incidence of gastric carcinoma subsequent to VBG and other gastric reductive and/or bypass procedures. Comparison is made of the increased incidence of gastric carcinoma over time, after gastric resective procedures for benign disease, versus the 'normal' incidence of gastric carcinoma, and the worse prognosis of gastric stump carcinoma. Noted is the recent observation, in a small series, of worrisome mucosal changes by endoscopic biopsies in patients after VBG, in the area of the pouch outlet. Long-term follow-up, with interval endoscopic biopsies and careful case reporting, will be important if we are to know the risk of eventual gastric carcinoma in these patients.

Gastric Stump Carcinoma Occurring in a Patient With Carney's Triad 38 Years After Partial Gastrectomy for Epithelioid Leiomyosarcoma

Gastric Stump Carcinoma Occurring in a Patient With Carney's Triad 38 Years After Partial Gastrectomy for Epithelioid Leiomyosarcoma

Gastric stump carcinoma occurring in a patient with Carney's triad 38 years after partial gastrectomy for epithelioid leiomyosarcoma

Carney's triad is a rare syndrome of unusual tumors first described in 1977 by Carney et al. 1 Articles in which over 40 patients have been described have appeared in the literature since then, with a review of 36 cases summarized in 1993. 2 The triad includes gastric epithelioid leiomyosarcoma, pulmonary chondroma, and functioning extra-adrenal paraganglioma. The tumors are commonly multicentric and only one third of the patients who were affected have manifested all three, most exhibiting two of the three tumors. 2 The triad affects predominantly young women, is usually heralded by signs and symptoms related to the gastric tumor, and patients can live years to decades with metastases of the gastric leiomyosarcoma. The cause of this rare syndrome has yet to be studied. We provide follow-up on a previously described patient with Carney's triad 3 who since developed signet-ring cell carcinoma of the gastric stump. The patient was

An experimental study of gastric stump carcinoma in Wistar rats.

The risk of gastric stump carcinoma is increased 15-20 years after gastric resection for benign disease. Reflux of duodenal juice, bacterial overgrowth and formation of N-nitroso compounds are possible etiological factors. There is a geographical variation in the incidence of gastric cancer, possibly explained by differences in food intake. Experimentally it is possible to induce gastric stump carcinoma in rats without the addition of exogenous carcinogens. The aim of this study was: 1) to find the incidence of gastric carcinoma in rats subjected to BII resection and followed for 10 months, and 2) to examine if acetic acid, a common dietary factor, could influence the development of gastric carcinoma. Amongst BII-operated male Wistar rats, infiltrating carcinoma was found in 5/20 on a normal diet and in 5/24 exposed to acetic acid (NS). Benign mucosal changes were seen in 12/20 and 16/24 respectively (NS). With the exception of a profound inflammation in one sham-operated animal, no mucosal pathological changes were found in 24 sham-operated and 24 control animals where no operation was performed.

Gastrin-physiological and pathophysiological role: clinical consequences.

Gastrin plays a central role in the regulation of acid secretion. It is released by meals in quantities sufficient to explain meal-stimulated acid secretion. Gastrin stimulates acid secretion mainly by releasing histamine from the enterochromaffin-like (ECL) cell. Whether gastrin has any functional direct effect on the parietal cell remains to be shown. Gastrin stimulates not only the function but also the growth of the ECL cell, and long-term hypergastrinemia may lead to ECL cell carcinoids. The role of the ECL cell in human gastric carcinogenesis is controversial, but it seems wise to avoid long-term iatrogen hypergastrinemia especially in young persons. Interestingly, the oxyntic mucosal D cell, on which gastrin has a negative trophic effect, may play a role in gastric stump carcinoma, and thus hypogastrinemia may also dispose to gastric cancer.

Pathogenesis of adenocarcinoma induced by gastrojejunostomy in Wistar rats: role of duodenogastric reflux.

The pathogenetic effect of duodenogastric reflux of the development of gastric stump carcinoma was studied experimentally. In this animal model, 95 male Wistar rats were subjected to a specially designed gastrojejunostomy to divert the duodenal contents into the resected stomach through the afferent and efferent loop. The rats were fed normally without any carcinogen administration. The incidence of adenocarcinomas around the anastomosis of afferent loop was 0% at 10 weeks, 18.8% at 20 weeks and 34.4% at 40 weeks, so the incidence was apt to rise in parallel with passing of the weeks. At 40 weeks, the rats had a significantly higher incidence of adenocarcinoma in the gastric mucosa around the afferent loop than around the efferent loop (P < 0.05). Of particular interest is that invasive growth of the cancerous tissue into the liver was observed in one animal. Polypoid lesions called 'atypical hyperplasia' in the present study were similar to gastritis cystica polyposa of humans. The development of adenocarcinoma was found to be intimately connected with atypical hyperplasia, which might be promoted by repeated destruction and regeneration by duodenogastric reflux. These results suggest that the direct contact of the duodenal juice with the gastric mucosa induces carcinoma in the anastomotic lesion. From the clinical perspective, our findings suggest that a surgical technique that minimizes the duodenogastric reflux should be chosen.

Chirurgische Therapie des Magenstumpfkarzinoms

BackgroundThe prognosis of the gastric stump cancer is said to be unfavourable as compared to primary gastric cancer in most published studies, as the diagnosis is made mainly in an advanced stage. The purpose of the study is the analysis of the own results after radical surgical treatment for gastric stump carcinoma.MethodsRadical tumorectomy combined with regional lymphadenectomy has been performed in 57 patients between 1978 and 1991. The median age at the time of primary gastric resection is 33 years, the free intervall until the diagnosis of the stump carcinoma is at 29 years.Results23 patients belong to the UICC-stage I, 15 to stage II, and 16 and 3 patients were classified as stage III and IV respectively. The overall 5-year survival probability is 60%, the median survival time is not reached during the observation time of 60 months.ConclusionsThere is no statistical difference of these results as compared with results obtained after radical surgery for primary gastric cancer. The reason for the particularly high percentage of 25% for the early gastric stump carcinoma in our hospital is due to a rigorous biannual endoscopic follow-up starting 15 years after previous gastric resection.

HIGHER FREQUENCY OF RAS ONCOGENE ACTIVATION IN GASTRIC STUMP CARCINOMAS DUE TO SPECIAL CONDITIONS IN THE GASTRIC REMNANT

Gastric stump carcinoma is now widely recognized to be due to special conditions in the gastric remnant. To examine whether the mechanism of carcinogenesis is different in gastric stump carcinoma from other gastric carcinoma, we analyzed ras mutation in 62 gastric carcinomas. The ras mutation frequency was 4/17 (23.5%) in stump carcinomas, 2/25 (8.0%) in other remnant carcinomas and 1/20 (5.0%) in proximal carcinomas. The mutation frequency in stump carcinomas was much higher than that in other gastric carcinomas. These results suggest that the mechanism of carcinogenesis in gastric stump carcinomas may be different from other gastric carcinomas.

Endoscopic Screening during 17 years for Gastric Stump Carcinoma: A Prospective Clinical Trial

In an attempt to reduce mortality in gastric stump carcinoma a defined cohort of operated peptic ulcer patients was followed up with an endoscopic screening programme. From 1930 and through 1960, 1575 patients were operated on for peptic ulcer disease at the Dept. of Surgery in Lund, Sweden. Of 838 still alive in January 1973, 682 were selected for geographical reasons and were offered endoscopic screening with biopsy at regular intervals. Three hundred and fifty-four patients came to the first examination. The follow-up programme was individualized thereafter with screening at 1- to 3-year intervals, depending on endoscopic and histologic findings. The remaining patients have, since then, constituted a control group, followed up only through death certificates and the Swedish Cancer Registry. By December 1989, 202 patients in the screening group had died and 320 in the control group. During the 17 years of follow-up 12 patients in the screening group died of gastric cancer, compared with 14 in the control group, even though 17 cases of early gastric cancer were diagnosed and operated on in the first group, compared with only 2 in the latter. We conclude that regular endoscopic screening does not reduce gastric cancer mortality and can thus not be recommended in asymptomatic patients previously subjected to partial gastric resection due to peptic ulcer disease.

The role of Campylobacter (Helicobacter) pylori in disorders of the gastrointestinal tract

To evaluate the role of Campylobacter pylori in different gastrointestinal disorders, serum IgG antibodies against C. pylori were determined in dyspeptic patients and in a control group of healthy children and adults. Twenty-eight percent of the dyspeptic patients with normal mucosa were seropositive. Among the patients with altered mucosa, the seroprevalence increased from duodenitis (48%) to gastritis (89%) and gastric or duodenal ulcer, gastric stump gastritis and carcinoma (100%, for each group, respectively). The C. pylori detection rate was lowest in patients with duodenitis alone (19%) and highest in patients with duodenal ulcers (95%). Therefore, C. pylori does not play an important role in patients with duodenitis alone. About 30% of patients with gastritis, active duodenal or gastric ulcer had antibody levels as low as the seroconverted dyspeptic patients but with normal gastroduodenal mucosa. C. pylori was not considered a causative factor for mucosal damage in these patients.

The Aetiology of Gastric Stump Carcinoma in the Rat

This study investigated the aetiology of gastric stump carcinoma in the rat. These carcinomas were induced by duodenogastric reflux without the need to administer carcinogens. Carcinoma was only detected when pancreatic exocrine secretions were present in the reflux. Malignant change was associated with dysplasia but not intestinal metaplasia or adenocystic proliferation of glands. The extent of resection increased tumour yield, but a truncal vagotomy did not. No difference was detected in intragastric pH, bacterial flora, or bile acid concentration between animals with and without carcinoma.

Pancreaticoduodenal secretions and the genesis of gastric stump carcinoma in the rat.

This study was designed to investigate the role of duodenogastric reflux in the genesis of gastric stump carcinoma in the rat. Carcinoma was not detected in any of the 11 control animals and in only one animal with a Roux diversion. In contrast seven of 12 animals with duodenogastric reflux developed carcinoma (p less than 0.01 and p less than 0.05 respectively). In order to determine which fraction of the reflux was implicated in the malignant process, animals with reflux of bile alone or pancreaticoduodenal secretions alone were studied. No carcinomas were found in 11 animals with bile reflux alone, but carcinoma was detected in 10 of 14 animals with reflux of pancreaticoduodenal secretions (p less than 0.01). The findings confirm that duodenogastric reflux is an important factor in the malignant process, and imply that the pancreaticoduodenal component, not bile is responsible.

Carcinoma of the gastric stump in China.

51 cases of gastric stump carcinoma were collected from 18 hospitals throughout China during the past 9.5 years. There were 47 males and 4 females, 41 cases (80.4 %) were over 50 years of age. The primary preceding diseases were: gastric ulcer 31, duodenal ulcer 17, and benign gastric lesion 3 cases. The types of previous operation were Billroth I in 29, Billroth I in 7, and not reported in 15 cases. The mean interval from the operation to the diagnosis of cancer was 13.8 years. 88 % of the present series had a definite diagnosis by fibergastroscopy and biopsy. The rest of the cases were diagnosed by postoperative pathologic examination. X-ray examination was positive in only 19 % of cases. The location of the cancer was at the anastomotic stoma in 45 %, in the body of stump in 36 %, and in the fundus in 19 %.

Pathological features and mucin histochemistry of primary gastric stump carcinoma associated with gastritis cystica polyposa. A study of six cases.

Six unusual cases of primary gastric stump carcinoma associated with gastritis cystica polyposa and arising in old gastrojejunostomy stomas are presented. The clinical data, the gross and microscopic pathological features, and the histochemical mucin profile of these two lesions are described in detail. A review is undertaken of the most relevant and previously published reports concerning, separately, either primary gastric stump carcinoma or gastritis cystica polyposa. The findings available in these reports are compared with those observed in our six cases. Some aspects of gastritis cystica polyposa are not unlike those seen in the solitary ulcer syndrome of the rectum and Ménétrier's disease. The histological type and mucin profile of primary gastric stump carcinoma parallel those recorded in gastric cancer arising in the unoperated stomach. However, the role of intestinal metaplasia and its histochemical typing appear somewhat different in primary gastric stump carcinoma.