Gastric Remnant Carcinoma Research Articles

The epigenetic modifier lysine methyltransferase 2C is frequently mutated in gastric remnant carcinoma.

Gastric remnant carcinoma (GRC), which occurs in the stomach after partial gastrectomy, is a rare and aggressive form of gastric adenocarcinoma (GAC). Comprehensive profiling of genomic mutations in GRC could provide the basis for elucidating the origin and characteristics of this cancer. Herein, whole-exome sequencing (WES) was performed on 36 matched tumor-normal samples from patients with GRC and identified recurrent mutations in epigenetic modifiers, notably KMT2C, ARID1A, NSD1, and KMT2D, in 61.11% of cases. Mutational signature analysis revealed a low frequency of microsatellite instability (MSI) in GRC, which was further identified by MSIsensor, MSI-polymerase chain reaction, and immunohistochemistry analysis. Comparative analysis demonstrated that GRC had a distinct mutation spectrum compared to that of GAC in The Cancer Genome Atlas samples, with a significantly higher mutation rate of KMT2C. Targeted deep sequencing (Target-seq) of an additional 25 paired tumor-normal samples verified the high mutation frequency (48%) of KMT2C in GRC. KMT2C mutations correlated with poor overall survival in both WES and Target-seq cohorts and were independent prognosticators in GRC. In addition, KMT2C mutations were positively correlated with favorable outcomes in immune checkpoint inhibitor-treated pan-cancer patients and associated with higher intratumoral CD3+ , CD8+ tumor-infiltrating lymphocyte counts, and PD-L1expression in GRC samples (p = 0.018, 0.092, 0.047, 0.010, and 0.034, respectively). Our dataset provides a platform for information and knowledge mining of the genomic characteristics of GRC and helps to frame new therapeutic approaches for this disease.

Evaluating the optimal treatment strategy for early and advanced remnant gastric cancer.

This study assessed lymph node metastasis characteristics to investigate the optimal treatment strategy for early and advanced remnant gastric cancer (RGC). Cases of completion gastrectomy for RGC were enrolled. The frequency of lymph node metastasis was investigated, and risk factors for metastasis were identified. The clinical significance of completion gastrectomy in early remnant gastric carcinoma cases was also examined. In advanced cases, 3-year survival was analysed to investigate the prognostic importance of lymph node dissection and splenectomy. Seventy-nine patients were included. Lymphatic invasion and pathological tumour depth were identified as risk factors for lymph node metastasis. There was no metastasis in the pT1 cases. In advanced cases, the incidence of lymph node #10 and jejunal lymph node metastasis was 8.3-10.0% and 17.6%, respectively. Prognosis was found to be unrelated with splenectomy. Lymphatic invasion and pathological T status were identified as risk factors for LN metastasis in RGC. Additional gastrectomy after ESD might not be mandatory for early RGC cases. For advanced RGC cases, splenectomy might not improve patient prognosis, however, lymph node dissection of jejunal and #10 lymph nodes should be considered due to its high incidence of metastasis.

Epstein\u2013Barr virus infection and genome polymorphisms on gastric remnant carcinoma: a meta-analysis

BackgroundPrevious studies reported that Epstein–Barr virus (EBV) may play a causal role in the pathogenesis of gastric remnant carcinoma (GRC). However, there was still some controversy.MethodsArticles published until July 15, 2020, in PubMed, MEDLINE, Embase and CNKI databases were selected. According to the inclusion criteria, corresponding data of included articles were abstracted and used for statistical analysis.ResultsThirteen papers were finally enrolled, nine of which showed the result that the risk of EBV infection rate in the GRC was higher than conventional gastric carcinoma (OR = 5.22, 95% CI 3.89–7.00). In addition, we found that EBV associated GRC (EBVaGRC) had higher rate of Billroth-II (OR = 3.80, 95% CI 1.90–7.57), carcinoma in anastomotic site (OR = 2.41, 95% CI 1.27–4.56) and diffuse type (Lauren classification) (OR = 1.97, 95% CI 1.04–3.73),while sex, initial diagnosis and lymphocytic infiltration were calculated no statistical difference. By genetic polymorphism analysis, “V-val” subtype of EBNA1 (OR = 21.84, 95% CI 11.92–31.76) and “C” subtype of BamHI-W1/I1 (OR = 7.07, 95% CI 1.47–34.03) were observed to be highly expressed in EBVaGRC.ConclusionEBV infection rate in the GRC was higher. Further analysis showed that Billroth-II, carcinoma in anastomotic site and diffuse type (Lauren classification) were associated to EBVaGRC. Through analysis of EBV genome polymorphisms, we thought that “V-val” subtype of EBNA1 and “C” subtype of BamHI-W1/I1 may become predictor of EBVaGRC.

A Resected Case of Remnant Gastric Carcinoma with Infiltration which Had Developed 24 Years after a Pancreatoduodenectomy

A Resected Case of Remnant Gastric Carcinoma with Infiltration which Had Developed 24 Years after a Pancreatoduodenectomy

Laparoscopic subtotal gastrectomy in morbid obese patients: a valid option to laparoscopic gastric bypass in particular circumstances (prospective study)

Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) without resection of the distal stomach is largely performed over the world for morbid obesity. Potential risk of gastric remnant carcinoma development has been suggested. To present the results obtained after LRYGB with resection of distal stomach. This prospective study includes 400 consecutive patients. The mean body weight was 105.9 ± 16.8 Kg (range 83-145kg), and body mass index (BMI) was 38.5 ± 4.4 kg/m2 (32.9-50.3). Postoperative morbid-mortality and follow-up were analyzed. Operative time was 128.5 ± 18.7min, hospital discharge occurred at 3rd postoperative day, postoperative complications occurred in 9.25%, early surgical complications were observed in 3% and medical complications 4%, late surgical complications occurred 2.25%, no mortality was observed. At 1year follow-up, BMI was 25.3 ± 2.7 kg/m2 with % of weight loss (%WL) of 84.6 + 19.1%. At five years follow-up very similar values were observed. The results obtained after LRYGB with resection of distal stomach are similar to results published after non resection LRYGB regarding early and late results and can be indicated in high risk areas of gastric carcinoma.

Abstract 119: Genomic analysis of remnant gastric adenocarcinoma

Abstract Introduction: Prior to pharmaceutical treatment of gastroduodenal ulcer disease, partial gastrectomy was performed for the management of ulcer disease complicated by bleeding (PUD). The proposed mechanism for the development of gastric cancer in this setting is the chronic irritation of the mucosa by duodenal reflux into the gastric remnant. The aim of this study is to characterize the genetic profile of remnant gastric carcinoma (RGC). Material and Methods: Thirty cases of RGC developed in the setting of prior partial gastrectomy for PUD and without neoadjuvant chemotherapy were retrospectively collected from the institution database. Histopathological evaluation was performed to ensure >80% tumor cellularity with matching normal gastric mucosa prior to DNA extraction. Ultra-deep targeted sequencing of the thirty matched pairs was performed using the MSK-IMPACT assay (Integrated Mutation Profiling of Actionable Cancer Targets) to identify mutations and copy number alterations in a common set of 410 cancer-associated genes. MSK-IMPACT data from previously sequenced 45 sporadic gastric carcinomas (GC) was used as comparison. Results: The cohort consisted of 22 (73%) males and 8 (27%) females with the mean age of 73 years. The median interval between PUD and RGC resections was 34.8 years (7-60 years). By Lauren's classification, 60% of the tumors were intestinal, 23% diffuse and 17% mixed. Most of the tumors (47%) were poorly differentiated and stage II (40%). MSK-IMPACT sequencing revealed 299 total somatic alterations occurring in 148 of 410 targeted genes with a median number of non-synonymous somatic mutations and copy number events of 3 and 1 per patient, respectively. Of the 207 total mutations, 27.5% were hotspot COSMIC and 23.2% were loss-of-function mutations. Recurrent genomic events included mutually exclusive mutations in TP53 (33%) and amplifications in MDM2 (26%), alterations in the ERBB family genes (37%), ARID1A (16%), KMT2D (13%), CDH1 (13%), and CDK4 (13%). In addition, actionable alterations in PIK3CA (10%), FGFR1 (4%), PTEN (4%), and concurrent hotspot KRAS mutations and inactivation of p15/p16 (10%) were observed. Compared to the sporadic GC cases, RGC cases presented differences in the landscape and recurrence of alterations. Conclusion: The pathogenesis of RGC is likely associated with the prolonged exposure of the gastric mucosa to gastroduodenal contents. The mean age of patients may also exert effects on the development of the RGC. Based on our sequencing results, RGC may present a genetic profile distinct from that of sporadic gastric tumors. Assessment of these alterations identified 30% of patients with potential therapeutic targets for the treatment of this disease and deserves further investigation. Citation Format: Edaise M. da Silva, Helen H. Won, Dianne Torrence, Daniel Coit, Michael F. Berger, Laura Tang. Genomic analysis of remnant gastric adenocarcinoma. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 119.

Epstein-Barr Virus Infection in Gastric Remnant Carcinoma and Recurrent Gastric Carcinoma in Qingdao of Northern China

BackgroundEpstein-Barr virus (EBV) is associated with a subset of gastric carcinoma which was defined as EBV associated gastric carcinoma (EBVaGC). The proportion of EBVaGC in gastric remnant carcinoma (GRC) which occurs in the intact stomach five or more years after gastric surgery for benign disease is significantly higher than that in conventional gastric carcinoma (CGC). The infection of EBV in recurrent gastric carcinoma (RGC) with local anastomotic recurrence is poorly understood.Methods53 cases of GRC and 58 cases of RGC were analyzed for the presence of EBV, and the variants of EBV Encoded RNAs (EBER), EBV Nuclear Antigen 1 (EBNA1) and Latent Membrane Protein 1 (LMP1) gene in both groups were investigated.ResultsThirteen (24.5%) out of 53 GRC cases and 3 (5.2%) out of 58 RGC cases were identified as EBVaGCs. In 17 paired RGC cases, only one case was classified as EBVaGC in both times specimen. Another one case was identified as EBVaGC in the primary gastroectomy specimen while the recurrent gastric cancer was not. The third EBVaGC in RGC was identified while the primary gastric cancer was not EBVaGC. In GRC and RGC cases, type 1, type F, EB-6m, V-val subtype, del-LMP1 were predominant type or variants, accounting for 10(76.9%) and 2(66.7%), 13(100%) and 3(100%), 13(100%) and 3(100%), 9(69.2%) and 3(100%), 12(92.3%) and 3(100%), respectively. However, Type C was the predominant type in GRC accounting for 9(69.2%) cases while type D was the predominant one accounting for 2(66.7%) cases in RGC.ConclusionsThe prevalence of EBVaGc in GRC and RGC was significantly different. The distributions of these variants were similar to each other in the two groups which indicated that there were no more aggressive EBV variants in EBVaGC in GRC compared with that in RGC.

Gastric remnant cancer patients had a better prognosis than upper-third gastric cancer patients in a case-control study after surgical treatment.

The aim was to compare the clinicopathological features and prognostic outcomes of gastric remnant carcinoma patients with those of patients with upper-third gastric cancer. Clinical data extracted from 112 gastric remnant carcinomas and 367 upper-third gastric cancer patients were analyzed to explore the clinicopathologic differences between two groups. After radical resection, prognostic difference between them was evaluated through a 1:2 matched case-control study. The pattern of gastric remnant carcinomas showed a male predominance. Undifferentiated type histology, depth at T4 stage and distant metastases were more frequent in gastric remnant carcinomas than in upper-third gastric cancers (P <0.05). The radical resectability of gastric remnant carcinomas was lower and the multi-visceral resectabilitiy was relatively higher than the other group (P = 0.00). Gastric remnant carcinomas trended to have a higher incidence of metastases to either mesojejunum or lower mediastinal lymph nodes than upper-third gastric cancers, but patient survival was not significantly different. In the case-control study, gastric remnant carcinomas had a better prognosis than upper-third gastric cancers after radical resection when the clinicopathologic features and surgical treatment were matched. Although there was no significant prognostic distinction between gastric remnant carcinomas and upper-third gastric cancer, after radical surgical treatment, patients with the former had an even better prognosis.

Surgical treatment of non-early gastric remnant carcinoma developing after distal gastrectomy for gastric cancer.

The optimal surgical procedure for gastric remnant carcinoma (GRC) remains debatable. The aim of this study was to retrospectively evaluate the surgical treatments for T2-4 GRC developing after distal gastrectomy for gastric cancer. Between 1970 and 2012, a total of 50 patients underwent R0 resection for T2-4 GRC. The clinicopathologic features, therapeutic methods, and follow-up data of these patients were reviewed. The tumor was located at a non-anastomotic site of the remnant stomach in 43 of the 50 patients. Total gastrectomy was performed in 48 patients and partial gastrectomy was in two patients. Lymph node metastasis was found in 19 patients. Major postoperative complications occurred in 16 patients. The overall 1-, 3-, and 5-year survival rates of the 50 patients were 90%, 66%, and 44%, respectively. Presence of small intestinal or esophageal infiltration and postoperative complications was independently associated with poorer survival. Dissection of the perigastric and splenic hilar/artery nodes was found to have potential therapeutic benefit. Surgical resection for T2-4 GRC developing after distal gastrectomy for gastric cancer can be invasive, but is feasible and effective. Total gastrectomy with splenectomy is one of the recommendable procedures for this disease.

Current status of function-preserving surgery for gastric cancer.

Recent advances in diagnostic techniques have allowed the diagnosis of gastric cancer (GC) at an early stage. Due to the low incidence of lymph node metastasis and favorable prognosis in early GC, function-preserving surgery which improves postoperative quality of life may be possible. Pylorus-preserving gastrectomy (PPG) is one such function-preserving procedure, which is expected to offer advantages with regards to dumping syndrome, bile reflux gastritis, and the frequency of flatus, although PPG may induce delayed gastric emptying. Proximal gastrectomy (PG) is another function-preserving procedure, which is thought to be advantageous in terms of decreased duodenogastric reflux and good food reservoir function in the remnant stomach, although the incidence of heartburn or gastric fullness associated with this procedure is high. However, these disadvantages may be overcome by the reconstruction method used. The other important problem after PG is remnant GC, which was reported to occur in approximately 5% of patients. Therefore, the reconstruction technique used with PG should facilitate postoperative endoscopic examinations for early detection and treatment of remnant gastric carcinoma. Oncologic safety seems to be assured in both procedures, if the preoperative diagnosis is accurate. Patient selection should be carefully considered. Although many retrospective studies have demonstrated the utility of function-preserving surgery, no consensus on whether to adopt function-preserving surgery as the standard of care has been reached. Further prospective randomized controlled trials are necessary to evaluate survival and postoperative quality of life associated with function-preserving surgery.

Gastric remnant cancer patients had a better prognosis than upper-third gastric cancer patients in a case-control study after surgical treatment

The aim was to compare the clinicopathological features and prognostic outcomes of gastric remnant carcinoma patients with those of patients with upper-third gastric cancer. Clinical data extracted from 112 gastric remnant carcinomas and 367 upper-third gastric cancer patients were analyzed to explore the clinicopathologic differences between two groups. After radical resection, prognostic difference between them was evaluated through a 1:2 matched case-control study. The pattern of gastric remnant carcinomas showed a male predominance. Undifferentiated type histology, depth at T4 stage and distant metastases were more frequent in gastric remnant carcinomas than in upper-third gastric cancers (P <0.05). The radical resectability of gastric remnant carcinomas was lower and the multi-visceral resectabilitiy was relatively higher than the other group (P = 0.00). Gastric remnant carcinomas trended to have a higher incidence of metastases to either mesojejunum or lower mediastinal lymph nodes than upper-third gastric cancers, but patient survival was not significantly different. In the case-control study, gastric remnant carcinomas had a better prognosis than upper-third gastric cancers after radical resection when the clinicopathologic features and surgical treatment were matched. Although there was no significant prognostic distinction between gastric remnant carcinomas and upper-third gastric cancer, after radical surgical treatment, patients with the former had an even better prognosis.

Variations of Epstein-Barr virus nuclear antigen 1 in Epstein-Barr virus-associated gastric carcinomas from Guangzhou, southern China.

Epstein-Barr virus (EBV) nuclear antigen 1 (EBNA1) is the only viral protein consistently expressed in all EBV-associated malignancies, and play a critical role in the onset, progression, and/or maintenance of these tumors. Based on the signature changes at amino acid residue 487, EBNA1 is classified into five distinct subtypes: P-ala, P-thr, V-leu, V-val and V-pro. In the present study, the sequence variations of EBNA1 in EBV-associated gastric carcinoma (EBVaGC) and throat washing (TW) samples of healthy EBV carriers in Guangzhou, southern China, where nasopharyngeal carcinoma (NPC) is endemic, were analyzed by PCR and DNA sequencing. V-val subtype was the most predominant (53.6%, 15/28) in EBVaGC, followed by P-ala (42.9%, 12/28) and V-leu (32.1%, 9/28) subtypes. In TWs of healthy EBV carriers, V-val subtype was also predominant (85.7%, 18/21). The sequence variations of EBNA1 in EBVaGC were similar to those in TW of healthy EBV carriers (p>0.05), suggesting that the EBV strains in EBVaGC might originate from the viral strains prevalent within the background population. The predominance of V-val subtype in EBVaGC in Guangzhou was similar to that in EBVaGC in northern China and Japan, but was different from that in EBVaGC in America, suggesting that the variations of EBNA1 in EBVaGC represent geographic-associated polymorphisms rather than tumor-specific mutations. In addition, the EBNA1 variations in EBVaGC in gastric remnant carcinoma were also determined. V-leu subtype was detected in all 4 (100%) cases, although 2 cases occurred as mixed infection with P-ala subtype. This is different from the predominant V-val subtype in EBVaGC in conventional gastric carcinoma, suggesting that V-leu might be a subtype that adapts particularly well to the microenvironment within the gastric stump and enters the remnant gastric mucosa epithelia easily. This, to our best knowledge, is the first investigation of EBNA1 polymorphisms in EBVaGC from endemic area of NPC.

Sequence Variations of Latent Membrane Protein 2A in Epstein-Barr Virus-Associated Gastric Carcinomas from Guangzhou, Southern China

Latent membrane protein 2A (LMP2A), expressed in most Epstein-Barr virus (EBV)-associated malignancies, has been demonstrated to be responsible for the maintenance of latent infection and epithelial cell transformation. Besides, it could also act as the target for a CTL-based therapy for EBV-associated malignancies. In the present study, sequence variations of LMP2A in EBV-associated gastric carcinoma (EBVaGC) and healthy EBV carriers from Guangzhou, southern China, where nasopharyngeal carcinoma (NPC) is endemic, were investigated. Widespread sequence variations in the LMP2A gene were found, with no sequence identical to the B95.8 prototype. No consistent mutation was detected in all isolates. The immunoreceptor tyrosine-based activation motif (ITAM) and PY motifs in the amino terminus of LMP2A were strictly conserved, suggesting their important roles in virus infection; while 8 of the 17 identified CTL epitopes in the transmembrane region of LMP2A were affected by at least one point mutation, which may implicate that the effect of LMP2A polymorphisms should be considered when LMP2A-targeted immunotherapy is conducted. The polymorphisms of LMP2A in EBVaGC in gastric remnant carcinoma (GRC) were for the first time investigated in the world. The LMP2A sequence variations in EBVaGC in GRC were somewhat different from those in EBVaGC in conventional gastric carcinoma. The sequence variations of LMP2A in EBVaGC were similar to those in throat washing of healthy EBV carriers, indicating that these variations are due to geographic-associated polymorphisms rather than EBVaGC-associated mutations. This, to our best knowledge, is the first detailed investigation of LMP2A polymorphisms in EBVaGC in Guangzhou, southern China, where NPC is endemic.

The Clinical Features and Prognosis of Gastric Remnant Carcinoma after Treatment

Introduction. The incidence of gastric remnant carcinoma does not decrease after partial gastrectomy. The aim of this study was to evaluate the clinical features and prognosis of gastric remnant carcinoma after treatment. Methods. Among 412 gastric carcinoma patients who were admitted to our hospital, 21 were found to have gastric remnant carcinoma. We analyzed their clinicopathological features and prognosis. Results. Prognosis did not differ significantly in terms of gender, age, tumor lymph node metastasis stage, tumor location, and time interval between first and subsequent operations. However, it was influenced by intensive curative gastrectomy with resection of local lymph nodes. Conclusion. Long-term follow-up after gastrectomy, appropriate curative resection, and prevention and management of comorbidities are important to detect gastric remnant carcinoma at an early stage.

Epstein-Barr virus genome polymorphisms of Epstein-Barr virus-associated gastric carcinoma in gastric remnant carcinoma in Guangzhou, southern China, an endemic area of nasopharyngeal carcinoma

Epstein-Barr virus (EBV) is associated with a subset of gastric carcinoma which was defined as EBV-associated gastric carcinoma (EBVaGC). The proportion of EBVaGC in gastric remnant carcinoma (GRC) was apparently higher than that in conventional gastric carcinoma (CGC) which occurs in the intact stomach. To clarify the possible mechanisms, 26 GRC cases from Guangzhou were investigated for the presence of EBV, and the EBV genome polymorphisms of EBVaGC in GRC were analyzed. Besides, the clinicopathologic characteristics, EBV latency pattern of EBVaGC in GRC were also investigated. Eight (30.8%) out of 26 cases were identified as EBVaGCs. Type A strain, prototype F, type I, mut-W1/I1, XhoI− and del-LMP1 variants were predominant among EBVaGC patients, accounting for 7 (87.5%), 7 (87.5%), 8 (100%), 6 (75%), 5 (62.5%) and 8 (100%) cases, respectively. All EBVaGC cases were male and with the histology of diffuse-type carcinoma. The tumor cells expressed EBNA1 (87.5%) and LMP2A (62.5%) but not LMP1, EBNA2 and ZEBRA. Thus, the EBV latency pattern was latency I. These were similar to those in CGC, except for the significantly higher proportion of EBVaGC in GRC than in CGC, suggesting that there is no more aggressive EBV variant in EBVaGC in GRC, and the injuries of gastric mucosa and/or changes of the microenvironment within the remnant stomach may be involved in the development of EBVaGC in GRC. This, to our knowledge, is the first study concerning about the EBV genome polymorphisms of EBVaGC in GRC in the world.

Epstein-Barr Virus (EBV) 関連胃癌手術7年後に発生したEBV関連残胃癌の1例

A 52-year-old man undergoing distal gastrectomy for gastric cancer in July 1998 was found to have a 0-IIa type gastric tumor near EC junction in January 2005. Histological examination showed the tumor was moderately differentiated adenocarcinoma. As the tumor was diagnosed as mucosal cancer, endoscopic mucosal dissection was performed. But pathological findings showed the depth of cancer cell invasion into deep submucosal layer. Then total resection of remnant stomach was performed. Both tumors were diagnosed as EBV-associated carcinoma. It is speculated that the mucosa changing after initial operation would give risk to a new occurrence of EBV-associated remnant gastric carcinoma. And then follow up after operation is important. Although some cases of EBV-associated remnant gastric carcinoma is found for short period after the primary surgery, our case second primary cancer was found 7 year after primary surgery. Long term follow-up by Endoscopy seems to be important.

Alpha-Fetoprotein-Producing Early Gastric Cancer of the Remnant Stomach: Report of a Case

A 67-year-old man initially underwent a distal gastrectomy for early gastric cancer (T1, N0, M0; Stage IA) in March 1995. During the follow-up period, an elevation of the serum alpha-fetoprotein (AFP) level (98.8 ng/ml) and a liver tumor (S4) were detected. A left hepatectomy was performed in December 1996. Immunohistochemically, AFP-positive cells were present in both the primary gastric tumor and metastasized liver tumor. The serum AFP level normalized immediately, but it elevated again to 22.4 ng/ml. An endoscopic examination revealed a protruding lesion in the remnant stomach. A total resection of the remnant stomach was performed in February 2005. The tumor was evaluated T1, N0, M0; Stage IA, with positive staining for AFP. The patient has survived without any sign of recurrence for more than 11 years after the first diagnosis of cancer. To the best of our knowledge, this is the first case of a long-term survival of AFP-producing gastric cancer with successfully resected metachronous liver metastasis and gastric remnant carcinoma.

Enteroliths developed in a chronically obstructed afferent loop coexisting with gastric remnant carcinoma: Case report and review of the literature

A case of gastric remnant carcinoma coexisting with a chronic afferent loop syndrome harboring multiple enteroliths in a grossly dilated and elongated afferent loop is presented herein. The patient had undergone a Polya type antecolic Billroth II reconstruction for a stenosing duodenal ulcer 40 years previously. A concise review of the relevant literature is also presented.

Laparoscopy-Assisted Resection of Gastric Remnant Cancer

We report a case of gastric remnant carcinoma (GRC) that was successfully treated by laparoscopy-assisted gastrectomy. A 69-year-old man was referred to our department for management of GRC. Preoperative investigations revealed a slightly elevated tumor, 5.0 cm in maximal diameter, confined to the gastric mucosa. Computed tomography and endoscopic ultrasonography identified no lymph node metastasis. Laparoscopy-assisted gastrectomy was performed including perigastric and mesenteric lymph node dissection. The postoperative course was uneventful. This is the first reported case of laparoscopically treated GRC. In cases with little adhesion from previous surgery, laparoscopic procedure might represent the treatment of choice for early GRC in terms of minimal invasiveness.

Epstein-Barr virus-associated gastric carcinoma in the remnant stomach: de novo and metachronous gastric remnant carcinoma

The remnant stomach corresponds to the gastric cardia, but is exposed to a completely different environment. The present study was performed to investigate the role of Epstein-Barr virus (EBV) infection in patients with gastric remnant carcinoma (GRC). Clinicopathological features, gastritis, and infection by EBV were investigated in patients with two types of GRC: GRC occurring at an interval of 10 years or longer between operations (de novo GRC group) and GRC occurring within 10 years after the initial operation for gastric carcinoma (metachronous GRC group). EBV involvement in the de novo GRC group (23%) was not significantly different from that in the cardia of non-remnant carcinomas (controls; 18%). EBV involvement showed greater correlations in male patients (18/63; 28%), and in those with gastritis cystica polyposa (GCP; 13/41; 31%), and those with an interval of 20 years or longer (15/50; 30%) than with the other parameters. Multivariate analysis showed a significant correlation between GCP and EBV infection. Histologically, hyperplasia or mild atrophy, and mild lymphocytic infiltration were observed in 56% and 67% of non-neoplastic mucosa of EBV-associated GRC, respectively. In the metachronous GRC group, EBV-encoded mRNA in situ hybridization (EBER-ISH) of 27 pairs of primary gastric carcinomas (GCs) and metachronous GRCs indicated that only six EBV (+) metachronous GRCs were derived from EBV (+) GC. Epstein-Barr virus infection, together with long-standing inflammation, which causes GCP, may facilitate the development of de novo GRC. Close follow-up of patients treated with distal gastrectomy for EBV-associated GC is necessary to detect metachronous GRC.