Gastric Stump Carcinoma Research Articles

Clinicopathological Predisposing Factors for Gastric Stump Cancer and Its Management: A Single-Center Analytical Study.

Background The incidence of gastric stump carcinoma (GSC) is not declining because of the long latency period. The survival rate of treated gastric cancer patients has increased due to early detection and improvements in surgical techniques and chemotherapy. Increased survival rates and improved surveillance following gastric surgery have increased the incidence of GSC. Aim The study aims to investigate the clinicopathological factors affecting the interval between index gastric surgery and the occurrence of GSC, and our experience in the management of GSC is presented. Methods A retrospective review of patients diagnosed with GSC in our institution was completed. Patient characteristics and clinicopathological outcomes were analyzed. Results A total of 28 patients were included in this cohort with 17 (60.71%) males and 11 (39.28%) females. The mean interval from index surgery to the incidence of GSC was 24.42 years for benign etiology and six years for malignant etiology. Index surgeries were truncal vagotomy with 14 gastrojejunostomies (50%) and 14 subtotal gastrectomies (50%). The interval between index surgery and the incidence of GSC is not statistically significant concerning the type of surgery (p: 0.661), pathological TNM (tumor, nodes, metastases) stage (p: 0.520), pathological differentiation (p: 0.828), lymphovascular invasion (p: 0.252), perineural invasion (p: 0.672), and adjuvant therapy (p: -0.655). Survival was significantly higher in those patients who received curative resection in comparison to a palliative procedure (p: 0.041). Conclusion Strict surveillance for at least 10 years after initial gastric surgery is of utmost importance as half of the patients fated to develop GSC will do so within this time. In those patients with early diagnosis, no evidence of metastasis, and good performance status, curative surgery is feasible with acceptable morbidity.

Surgical treatment of gastric stump carcinoma after Whipple procedure: A case report.

Gastric stump carcinoma (GSC) is very exceptional and little known after Whipple procedure, and its diagnosis and treatment are extremely difficult to handle. The patient, a 68-year-old man, visited our hospital's General surgery outpatient clinic complaining of upper abdominal pain that had been bothering him for half a month. The endoscopy revealed lesions in the stomach residual, and the pathological results suggested adenocarcinoma. The patient underwent Whipple procedure for periampullary adenocarcinoma in the 4th year ago. The final diagnosis was gastric adenocarcinoma and its pathological stage was Ⅱ A (T3N0M0). The patient underwent stump gastrectomy and end-to-side esophagojejunostomy (Roux-en-Y reconstruction). The operation went smoothly and the patient recovered well with only mild bloating and nausea, and the symptoms completely disappeared during the hospital stay. The development of GSC several years after Whipple procedure is uncommon. This is the first case from China that has received international attention. Early diagnosis is crucial. Surgery is considered to be the most effective treatment for GSC after Whipple procedure if long-term survival is possible and surgical risks are controllable.

Appraisal of gastric stump carcinoma and current state of affairs.

Gastric stump carcinoma, also known as remnant gastric carcinoma, is a malignancy arising in the remnant stomach following gastrectomy for a benign or malignant condition. Enterogastric reflux and preexisting risk factors in a patient with gastric cancer are the major contributors to the development of gastric stump carcinoma. The occurrence of gastric stump carcinoma is time-dependent and seen earlier in patients operated on for malignant rather than benign diseases. The tumor location is predominantly at the anastomotic site towards the stomach. However, it can occur anywhere in the remnant stomach. The pattern of lymph node involvement and the type of surgery required is distinctly different compared to primary gastric cancer. Gastric stump carcinoma is traditionally considered a malignancy with a dismal outcome. However, recent advances in diagnostic and therapeutic strategies have improved outcomes. Recent advances in molecular profiling of gastric stump carcinoma have identified distinct molecular subtypes, thereby providing novel therapeutic targets. Also, reports of gastric stump carcinoma following pancreatoduodenectomy and bariatric surgery highlight the need for more research to standardize the diagnosis, staging, and treatment of these tumors. The present review aims to provide an overview of gastric stump carcinoma highlighting the differences in clinicopathological profile and management compared to primary gastric carcinoma.

Ex Situ In Vivo Technique of Spleen-Preserving Splenic Hilar Lymph Node Dissection in Operable Proximal Gastric Adenocarcinoma.

D2 gastrectomy is the globally accepted standard surgical procedure for operable gastric cancer, and lymph node (LN) dissection is considered as the critical part of radical surgery and closely related to the prognosis. The splenic hilar LN (SHLN) or level 10 are to be removed during standard D2 total gastrectomy. In situ and ex situ spleen-preserving lymphadenectomies have been the most common dissection approaches for SHLNs. No study exists which compares the outcomes of these techniques in Indian population. This study is aimed to analyse the operative outcomes of ex situ in vivo technique of spleen-preserving splenic hilar lymph node dissection in patients who underwent D2 total gastrectomy for operable proximal gastric cancer in comparison with in situ in vivo technique of splenic hilar lymph node dissection. We reviewed prospectively collected data from 17 patients with operable proximal gastric cancer between September 2016 and April 2019 who underwent D2 total gastrectomy with splenic hilar lymph node dissection and studied the preoperative demographic factors, operative and postoperative outcomes comparing the different operative techniques. Patients with oesophago-gastric junction involvement, direct splenic or other adjacent organ invasion requiring multivisceral resection and gastric stump carcinoma were excluded. Overall, 17 patients underwent D2 total gastrectomy for operable gastric cancer. Mean age of presentation was 54.7 years including 13 males and 4 females. Five patients had middle third and 12 patients had upper third cancer. All patients had splenic hilar nodal clearance as follows: in situ - 14 and ex situ - 3 patients. R0 resection was achieved in all patients. Lymph node harvest tends to be higher with lower operative time and blood loss in patients with ex situ technique compared to in situ technique with similar morbidity. Ex situ in vivo technique of spleen-preserving splenic hilar lymph node dissection can be considered as both safe and feasible procedure for operable proximal gastric cancer patients in experienced centres to achieve better lymph node yield with no significant increase in morbidity.

Is there difference between anastomotic site and remnant stump carcinoma in gastric stump cancers?-a single institute analysis of 90 patients.

Little has been reported regarding differences between malignancies that develop at the anastomotic site (ASC) and those that develop at the remnant stump (RSC) in gastric stump carcinomas (GSC). The purpose of our study was to compare clinical, pathological and survival characteristics of ASC patients with those of RSC patients. Patients who underwent surgery for GSC between January 2005 and December 2017 were analyzed. Of the total 112 patients, 22 patients were excluded from the study due to extensive loss of data. Ninety patients underwent curative resection and were evaluated based on anatomic site at which they developed malignancy, i.e., ASC and RSC. Clinical, pathological and survival characteristics were assessed. As per Lauren's classification, diffuse and intestinal variety were significantly associated with ASC (P=0.0001) and RSC (P=0.0001) respectively. RSC was associated with lower pT [pT2, 15/33 (45.5%), P=0.0002]. ASC was significantly associated with higher pN [pN3, 30/57 (52.6%), P=0.0013], stage [stage III, 48/57 (84.2%), P=0.0022], positive mesenteric nodes (P=0.006) and poor 3-year survival (10.5% versus 36.4%, P=0.003). ASC is substantially different than RSC. ASC is more aggressive disease compared to RSC and has different pathophysiology, higher rates of nodal involvement (both primary and mesenteric), presents with higher stage and has significantly poor 3-year survival.

Gastric stump carcinoma as a long-term complication of pancreaticoduodenectomy: report of two cases and review of the English literature

BackgroundGastric stump carcinoma is an exceptional and poorly known long-term complication after pancreaticoduodenectomy.Cases presentationTwo patients developed gastric stump carcinoma 19 and 10 years after pancreaticoduodenectomy for malignant ampulloma and total pancreaticoduodenectomy for pancreatic adenocarcinoma, respectively. Both patients had pT4 signet-ring cell carcinoma involving the gastrojejunostomy site that was revealed by bleeding or obstruction. Patient 1 is alive and remains disease-free 36 months after completion gastrectomy. Patient 2 presented with peritoneal carcinomatosis and died after palliative surgery. We identified only 3 others cases in the English literature.ConclusionsProlonged biliary reflux might be the most important risk factor of gastric stump carcinoma following pancreaticoduodenectomy. Its incidence might increase in the future due to prolonged survival observed after pancreaticoduodenectomy for benign and premalignant lesions.

Short- and Long-Term Outcomes in Malnourished Patients After Laparoscopic or Open Radical Gastrectomy.

The aim of this study was to compare the short- and long-term outcomes of malnourished gastric cancer patients who underwent laparoscopic or open radical gastrectomy. Preoperative malnutrition is an independent risk factor for postoperative mortality and morbidity in major gastrointestinal surgery. However, whether laparoscopic surgery can improve the short- and long-term outcomes of malnourished gastric cancer patients has not been determined. We reviewed prospectively collected data from 2441 patients with gastric cancer between January 2009 and December 2014 and compared the short- and long-term outcomes in malnourished gastric cancer patients who underwent laparoscopic or open radical gastrectomy. Nutritional risk factors included weight loss >10% within 6months, body mass index <18.5kg/m2, Subjective Global Assessment Grade C, and serum albumin <3.0g/dL. Overall, 501 patients (20.52%) were classified as malnourished. Patients with gastric stump carcinoma, neoadjuvant chemotherapy, distant metastases, palliative operation, or the presence of other malignancies were excluded. Finally, a total of 412 patients were analyzed; 304 in the laparoscopic group and 108 in the open group. There were no significant differences between the two groups regarding the clinicopathological characteristics. However, the operation time (181±53 vs. 253±81min), intraoperative blood loss (80±116 vs. 322±502mL), time to first ambulation (2.21±1.04 vs. 2.55±1.50days), liquid diet (4.91±1.61 vs. 5.72±2.09days) and semiliquid diet (7.67±1.56 vs. 9.53±2.09days) as well as the postoperative hospital stay duration (13.00±6.56 vs. 15.22±6.87days) were significantly lower in the laparoscopic group than those in the open group (p<0.05). The instances of overall complications (laparoscopic vs. open: 18.4 vs. 30.6%, p=0.008) and pneumonia (laparoscopic vs. open: 10.9 vs. 19.4%, p=0.023) were significantly lower in the laparoscopic group. With a median follow-up of 31.0months (range 1.0-88.0), the 3-year overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) rates for the entire cohort were 58.9, 54.0 and 63.0%, respectively. Further analysis showed that the OS (57.5 vs. 59.4%, p=0.560), RFS (51.8 vs. 54.8%, p=0.441) and CSS (62.8 vs. 63.0%, p=0.789) between the laparoscopic and open groups, respectively, were no significantly different. Further analysis showed no significant differences in the OS rates of the two groups of patients stratified by tumor stage (p>0.05). Compared with open radical gastrectomy, laparoscopy would reduce the postoperative complications especially pneumonia and shorten the postoperative hospital stay for patients with preoperative malnutrition without affecting their long-term survival.

P-120 - Short- and long-term outcomes in malnourished patients after laparoscopic or open radical gastrectomy

Introduction: Preoperative malnutrition is an independent risk factor for postoperative mortality and morbidity in major gastrointestinal surgery. However, whether laparoscopic surgery can improve the short- and long-term outcomes of malnourished gastric cancer patients has not been determined. The aim of this study was to compare the short- and long-term outcomes of malnourished gastric cancer patients who underwent laparoscopic or open radical gastrectomy. Methods: We reviewed prospectively collected data from 2441 patients with gastric cancer between January 2009 and December 2014 and compared the short- and long-term outcomes in malnourished gastric cancer patients who underwent laparoscopic or open radical gastrectomy. Results: Overall, 501 patients (20.52%) were classified as malnourished. Patients with gastric stump carcinoma, neoadjuvant chemotherapy, distant metastases, palliative operation, or the presence of other malignancies were excluded. Finally, a total of 412 patients were analyzed; 304 in the laparoscopic group and 108 in the open group. The operation time (181±53 min vs 253±81 min), intraoperative blood loss (80±116 ml vs 322±502 ml), and the postoperative hospital stay duration (13.00±6.56 days vs 15.22±6.87 days) were significantly lower in the laparoscopic group than in the open group (p < 0.05). The instances of overall complications (laparoscopic vs open: 18.4% vs 30.6%, p = 0.008) and pneumonia (laparoscopic vs open: 10.9% vs 19.4%, p = 0.023) were significantly lower in the laparoscopic group. With a median follow-up of 31.0 months (range, 1.0-88.0), the 3-year overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) rates for the entire cohort were 59.1%, 54.2% and 63.2%, respectively. Further analysis showed that the OS (57.5% vs 59.7%, p = 0.529), RFS (51.8% vs 55.1%, p = 0.414) and CSS (62.8% vs 63.4%, p = 0.750) between the laparoscopic and open groups, respectively, were no significantly different. Further analysis showed no significant differences in the OS rates of the two groups of patients stratified by tumor stage (p > 0.05). Conclusion: Compared with open radical gastrectomy, laparoscopy would reduce the postoperative complications and shorten the postoperative hospital stay for patients with preoperative malnutrition without affecting their long-term survival.

Gastroenterostoma after Billroth antrectomy as a premalignant condition.

Gastric stump carcinoma (GSC) following remote gastric surgery is widely recognized as a separate entity within the group of various types of gastric cancer. Gastrectomy is a well established risk factor for the development of GSC at a long time after the initial surgery. Both exo- as well as endogenous factors appear to be involved in the etiopathogenesis of GSC, such as achlorhydria, hypergastrinemia and biliary reflux, Epstein-Barr virus and Helicobacter pylori infection, atrophic gastritis, and also some polymorphisms in interleukin-1β and maybe cyclo-oxygenase-2. This review summarizes the literature of GSC, with special reference to reliable early diagnostics. In particular, dysplasia can be considered as a dependable morphological marker. Therefore, close endoscopic surveillance with multiple biopsies of the gastroenterostomy is recommended. Screening starting at 15 years after the initial ulcer surgery can detect tumors at a curable stage. This approach can be of special interest in Eastern European countries, where surgery for benign gastroduodenal ulcers has remained a practice for a much longer time than in Western Europe, and therefore GSC is found with higher frequency.

Retrospective clinical analysis of surgical treatment for gastric stump carcinoma

To investigate the clinical feature and surgical procedures of gastric stump carcinoma (GSC) and to identify the prognostic factors which influence survival rate of GSC patients. Clinical data of 167 patients who underwent R0 resection for gastric stump carcinoma at Chinese People's Liberation Army General Hospital between January 1990 and December 2012 was collected. There were 144 male and 23 female cases. The clinicopathological features of GSC patients were compared between those who underwent initial surgery for benign disease (GSC-B group, 78 cases) and for gastric cancer (GSC-M group, 89 cases). The analysis of therapeutic methods and survival time were also performed.t-test was used to compare the quantitative data between two groups. Pearson χ(2) test was used to compare the various clinicopathological characteristics between the two groups. Kaplan-Meier method was used to analyze the survival rate. Multivariate survival analysis was based on the Cox proportional hazard model. Compared with GSC-M group, the interval time between initial gastrectomy and surgery in GSC-B group was longer ( (28.2±10.2) years vs. (10.8±1.0) years, t=15.902, P=0.001). There were 56 patients (71.8%) who received BillrothⅠ reconstruction in GSC-B group, and 49 patients (55.1%) who received BillrothⅡ reconstruction in GSC-M group, the difference of anastomosis method between the two groups was statistically significant (χ(2)=25.770, P=0.001). Compared with GSC-M group, the tumor of GSC-B group was usually located at the anastomotic site (χ(2)=6.975, P=0.031). The overall 1-, 3-, and 5-year survival rates of the 167 patients were 87%, 60%, and 41%. The 5-year survival rates for TNM stagesⅠ, Ⅱ, and Ⅲ were 65%, 43%, and 22%, respectively (P= 0.001). Multivariate analysis showed that small intestinal or esophageal infiltration (HR=1.957, 95%CI: 1.096 to 3.494, P=0.023), tumor location (HR=1.618, 95%CI: 1.104 to 2.372, P=0.014), and TNM stage (HR=2.307, 95%CI: 1.708 to 3.118, P=0.001) have independent effect on survival. The metastasis rates of perigastric lymph nodes, jejunum anastomosis and mesenteric lymph nodes were very high (56.3% and 65.2%, respectively). The GSC appears earlier in patients with gastrectomy for malignant disease than those with benign disease. Appropriate curative resection including residual lymph node dissection is very important to improve the prognosis. Small intestinal or esophageal infiltration, tumor location, and TNM stage have independent effect on survival.

Afferent Limb Syndrome Presenting as Pancreatitis Due to Obstructing Gastric Stump Carcinoma

Afferent Limb Syndrome Presenting as Pancreatitis Due to Obstructing Gastric Stump Carcinoma

Gastric stump carcinoma after distal subtotal gastrectomy for early gastric cancer: experience of 541 patients with long-term follow-up

BackgroundGastric stump carcinoma (GSC) has been studied after primary gastrectomy for benign disease but few studies have evaluated its correlation with gastric cancer. PatientsWe assessed 541 patients submitted to subtotal gastrectomy for early gastric cancer at least 15 years ago. ResultsGSC was diagnosed in 16 (2.9%) patients, giving a 4% cumulative risk of GSC 20 years after surgery. Diagnosis was made within 5 years of surgery in 10 patients and after 8 years in 6 cases. GSC occurred in 13/470 (2.8%) patients submitted to Billroth 2 reconstruction, 2/30 (6.7%) patients who underwent Billroth 1, and 1/41 (2.4%) patients after Roux-en-Y reconstruction. Significant risk factors observed for GSC were histologic type and sex. Other synchronous or metachronous extragastric tumors were registered in 56 (11.2%) patients. ConclusionsThe risk of GSC was low, even 20 years after subtotal gastrectomy for early gastric cancer. Lauren intestinal histotype and male sex were frequently associated with GSC. No correlation was observed between GSC and reconstruction technique or multifocality. Clinically speaking, GSC could be considered a subset of gastric cancer.

Polypoid colonic metastases from gastric stump carcinoma: A case report.

The present study aimed to investigate polypoid colonic metastases from gastric stump carcinoma by performing a retrospective analysis of the clinical data of a patient with such a diagnosis, and by discussing other previous case studies from the literature. The patient of the present study was an 80-year-old male who had undergone a gastrectomy 48 years previously for a benign perforated gastric ulcer. A colonoscopy revealed >10 multiple polypoid lesions of 6–10 mm in diameter distributed throughout the entire colon, except in the rectum. Each lesion had either erosion or a depression at the top and several were covered with a white fur-like substance. Biopsy specimens excised from the stomach showed a poorly-differentiated adenocarcinoma with diffuse signet ring cells, and a colonoscopy-guided biopsy revealed a signet ring cell adenocarcinoma. The patient was referred to the Oncology unit (Beijing Shijitan Hospital, Beijing, China) for assessment and chemotherapy treatment, which was initiated with 1,000 mg Xeloda orally administered twice a day for two-week courses every three weeks. The patient succumbed to upper gastrointestinal hemorrhage and pneumonia after three months. Gastric or gastric stump carcinoma may metastasize to the colon presenting as solitary or multiple colonic polyps. Thus, it is important to consider this diagnosis as such colon metastases may mimic solitary or multiple colonic polyps, which are commonly observed. A differential diagnosis is required in this complicated situation.

Gastric cancer arising from the remnant stomach after distal gastrectomy: a review.

Gastric stump carcinoma was initially reported by Balfore in 1922, and many reports of this disease have since been published. We herein review previous reports of gastric stump carcinoma with respect to epidemiology, carcinogenesis, Helicobacter pylori (H. pylori) infection, Epstein-Barr virus infection, clinicopathologic characteristics and endoscopic treatment. In particular, it is noteworthy that no prognostic differences are observed between gastric stump carcinoma and primary upper third gastric cancer. In addition, endoscopic submucosal dissection has recently been used to treat gastric stump carcinoma in the early stage. In contrast, many issues concerning gastric stump carcinoma remain to be clarified, including molecular biological characteristics and the carcinogenesis of H. pylori infection. We herein review the previous pertinent literature and summarize the characteristics of gastric stump carcinoma reported to date.

Laparoscopic radical gastrectomy for gastric stump carcinoma

Gastric stump carcinoma (GSC) generally refers to the primary cancer in the remnant stomach,which occurs 5 years or latter after subtotal gastrectomy for gastric or duodenal ulcer,or 10 years or latter after gastric cancer resection.Laparoscopic radical gastrectomy for GSC is difficult with low resection rate.Although laparoscopic gastrectomy is technically mature in recent years,there is still few reports about laparoscopic resection for GSC.From January 2009 to June 2012,18 patients with GSC received laparoscopic radical gastrectomy at the General Hospital of Lanzhou Military Area of PLA.Laparoscopic gastrectomy for GSC is technically feasible and safe with satisfactory short-term outcome.Surgeons who have mastered laparoscopic D2 dissection could perform this procedure. Key words: Gastric neoplasms; Laparoscopy; Gastrectomy

Spontaneous clearance of Helicobacter pylori after pylorus-preserving gastrectomy for gastric cancer

Residual mucosa in the gastric stump after pylorus-preserving gastrectomy (PPG) is considered a risk factor for the development of gastric stump carcinoma (GSC). Duodenogastric reflux (DGR) and Helicobacter pylori (H. pylori) infection are suspected to contribute to the development of GSC. The aim of this study was to investigate the prevalence of H. pylori in the residual stomach after PPG for gastric cancer and to assess factors associated with the presence of H. pylori. We investigated 72 patients who had undergone PPG at least 1 year prior to the study and were confirmed to be positive for H. pylori infection on presurgical endoscopic biopsy. The extent of DGR, the prevalence of H. pylori infection based on H. pylori stool antigen (HpSA) tests and the severity of gastritis were analyzed in these post-PPG patients. None of the patients had DGR, as shown by (99m)Tc-PMT. Of the 72 post-PPG patients, 33 (46%) were positive for HpSA. The prevalence of H. pylori infection was significantly lower after surgery than before surgery. The endoscopic severity of remnant gastritis, as well as histological inflammation and activity, were higher in H. pylori-positive patients than in H. pylori-negative patients. In conclusion, some patients who undergo PPG and are negative for DGR experience spontaneous clearance of H. pylori infection.

Function-Preserving Gastrectomy for Early Gastric Cancer

The number of early gastric cancer (EGC) cases has been increasing because of improved diagnostic procedures. Applications of function-preserving gastric cancer surgery may therefore also be increasing because of its low incidence of lymph node metastasis, excellent survival rates, and the possibility of less-invasive procedures such as laparoscopic gastrectomy being used in combination. Pylorus-preserving gastrectomy (PPG) with radical lymph node dissection is one such function-preserving procedure that has been applied for EGC, with the indications, limitations, and survival benefits of PPG already reported in several retrospective studies. Laparoscopy-assisted proximal gastrectomy has also been applied for EGC of the upper third of the stomach, although this procedure can be associated with the 2 major problems of reflux esophagitis and carcinoma arising in the gastric stump. In the patient with EGC in the upper third of the stomach, laparoscopy-assisted subtotal gastrectomy with a preserved very small stomach may provide a better quality of life for the patients and fewer postoperative complications. Finally, the laparoscopy endoscopy cooperative surgery procedure combines endoscopic submucosal dissection with laparoscopic gastric wall resection, which prevents excessive resection and deformation of the stomach after surgery and was recently applied for EGC cases without possibility of lymph node metastasis. Function-preserving laparoscopic gastrectomy is recommended for the treatment of EGC if the indication followed by accurate diagnosis is strictly confirmed. Preservation of remnant stomach sometimes causes severe postoperative dysfunctions such as delayed gastric retention in PPG, esophageal reflux in PG, and gastric stump carcinoma in the remnant stomach. Moreover, these techniques present technical difficulties to the surgeon. Although many retrospective studies showed the functional benefit or oncological safety of function-preserving gastrectomy, further prospective studies using large case series are necessary.

Prognosis of patients with gastric cancer and solitary lymph node metastasis

To investigate the relationship of solitary lymph node metastasis (SLNM) and age with patient survival in gastric cancer (GC). The medical records databases of China's Beijing Cancer Hospital at the Peking University School of Oncology and Shanghai Tenth People's Hospital affiliated to Tongji University were searched retrospectively to identify patients with histologically proven GC and SLNM who underwent surgical resection between October 2003 and December 2012. Patients with distant metastasis or gastric stump carcinoma following resection for benign disease were excluded from the analysis. In total, 936 patients with GC + SLNM were selected for analysis and the recorded parameters of clinicopathological disease and follow-up (range: 13-2925 d) were collected. The Kaplan-Meier method was used to stratify patients by age (≤ 50 years-old, n = 198; 50-64 years-old, n = 321; ≥ 65 years-old, n = 446) and by metastatic lymph node ratio [MLR < 0.04 (1/25), n = 180; 0.04-0.06 (1/25-1/15), n = 687; ≥ 0.06 (1/15), n = 98] for 5-year survival analysis. The significance of intergroup differences between the survival curves was assessed by a log-rank test. The 5-year survival rate of the entire GC + SLNM patient population was 49.9%. Stratification analysis showed significant differences in survival time (post-operative days) according to age: ≤ 50 years-old: 950.7 ± 79.0 vs 50-64 years-old: 1697.8 ± 65.9 vs ≥ 65 years-old: 1996.2 ± 57.6, all P < 0.05. In addition, younger age (≤ 50 years-old) correlated significantly with mean survival time (r = 0.367, P < 0.001). Stratification analysis also indicated an inverse relationship between increasing MLR and shorter survival time: < 0.04: 52.8% and 0.04-0.06: 51.1% vs ≥ 0.06: 40.5%, P < 0.05. The patients with the shortest survival times and rates were younger and had a high MLR (≥ 0.06): ≤ 50 years-old: 496.4 ± 133.0 and 0.0% vs 50-65 years-old: 1180.9 ± 201.8 and 21.4% vs ≥ 65 years-old: 1538.4 ± 72.4 and 37.3%, all P < 0.05. The same significant trend in shorter survival times and rates for younger patients was seen with the mid-range MLR group (0.04-0.06), but the difference between the two older groups was not significant. No significant differences were found between the age groups of patients with MLR < 0.04. Assessment of clinicopathological parameters identified age group, Borrmann type, histological type and tumor depth as the most important predictors of the survival rates and times observed for this study population. GC patients below 51 years of age with MLR of SLNM above 0.06 have shorter life expectancy than their older counterparts.

A Caliber Persistent Artery (Dieulafoy’s Lesion) which is Associated with an Early-Stage Gastric Stump Cancer Following a Distal Gastrectomy

A 75-years old man was hospitalized with symptoms which suggested gastric cancer. Thirty-eight years ago, he had undergone a Billroth-II gastric reconstruction for a peptic ulcer. At the present admission, he had presented with an eight-month history of recurrent haematemesis, epigastric pain, vomiting, and fatigue. The emergent endoscopy showed a type 0-IIc (superficial depressed) early gastric stump cancer in the anastomotic area and total removal of the gastric remnant and the jejunal segment was performed. The histological examination of the surgical specimen showed a gastric adenocarcinoma that invaded the mucosa and the submucosa, without lymph node metastases (pT1bN0 stage). Besides the tumour, enlarged vessels were observed in the submucosa and the muscularis propria, some of which were thrombotic. The surrounding normal gastric wall also presented submucosal oversized vascular spaces, some of which were protruding through the muscularis mucosae in the mucosal layer. Based on these characteristics and the recurrent haematemesis, a final diagnosis of early gastric stump carcinoma which was associated with Dieulafoy's lesion was made. This association has not yet been reported in the literature and it allowed us to diagnose the gastric stump cancer in a very early stage.

Clinicopathological Characteristics and Survival Difference Between Gastric Stump Carcinoma and Primary Upper Third Gastric Cancer

BackgroundThe increased incidence of early gastric cancer in several Asian countries has been associated with an increase in gastric stump carcinoma (GSC) following gastric cancer surgery. The clinicopathological characteristics of GSC remain unclear because of the limited number of patients with GSC. MethodsThe clinicopathological characteristics, including the 5-year survival rate of patients with GSC following distal gastrectomy (167 patients), were compared with those of patients with primary upper third gastric cancer (PGC; 755 patients). The clinicopathological characteristics of patients with GSC were also compared between those who had initial surgery for gastric cancer (GSC-M group, 78 patients) and for benign lesions (GSC-B group, 89 patients). ResultsThe GSC-B group has a greater male/female ratio (13.8 vs. 3.1) and a longer interval between initial gastrectomy and surgery for GSC (31.0 vs. 9.4 years) than the GSC-M group. The 5-year survival rate was not significantly different between the GSC-B group (49.0 %) and the GSC-M group (59.3 %, P = 0.359). A comparison between the GSC group and the PGC group revealed a poorer 5-year survival rate for the GSC group (53.6 %) than the PGC group (78.3 %, P < 0.001), and the same trend was observed even after stratification by the pathological stage. ConclusionsStump carcinoma arises earlier following gastrectomy for malignant disease than for benign disease. The prognosis was poor in patients with GSC compared to those with PGC. Early detection of GSC is necessary and an appropriate follow-up program should be established.