Current State of Gastric Stump Carcinoma in Japan: Based on the Results of a Nationwide Survey
Open Access
- 25 February 2010
- journal article
- research article
- Published by Wiley in World Journal of Surgery
- Vol. 34 (7), 1540-1547
- https://doi.org/10.1007/s00268-010-0505-5
Abstract
Background Carcinoma of the gastric remnant after partial gastrectomy for benign disease or cancer is unusual but an important cancer model. The Japanese Society for the Study of Postoperative Morbidity after Gastrectomy (JSSPMG) performed a nationwide questionnaire survey to understand the current state of gastric stump carcinoma in Japan. Methods In the questionnaire survey of November 2008, gastric stump carcinoma was defined as an adenocarcinoma of the stomach occurring 10 years or more after Billroth I or Billroth II gastrectomy for benign condition or cancer disease. The survey was conducted at the request of reports on five or more patients with gastric stump carcinoma for each institution. Items for the survey included gender, age, methods of reconstruction in an original gastrectomy, original diseases, time interval between original gastrectomy and first detection of stump carcinomas, locations of stump carcinomas, tumor histology, tumor depth, and extent of lymph node metastasis. The questionnaire was sent to 163 surgical institutions in the JSSPMG. Results Ninety-five institutions (58.3%) responded to the survey, and the data of 887 patients satisfied the required conditions for the survey. A total of 887 patients were composed of 368 patients who received Billroth I distal gastrectomy and 519 who received Billroth II. The Billroth II group has a significantly higher number of original benign lesions than the Billroth I group (P < 0.001). This study confirmed the following issues: (1) The remnant stomach after gastrectomy for cancer disease had a higher prevalence to develop stump carcinomas occurring in a shorter time interval since original gastrectomy; (2) Patients with Billroth II gastrectomy had stump carcinomas most frequently in the anastomotic area, but not in the non-stump area as in Billroth I gastrectomy; (3) Tumor histology of 72.4% of 304 stump carcinomas at an early stage was intestinal type adenocarcinoma, i.e., well or moderately differentiated adenocarcinoma, whereas it decreased to 42.2% at the locally advanced stage of 521 stump carcinomas (P = 0.0015), suggesting that stump carcinoma mostly may develop from intestinal type and change to diffuse type during the evolution to advanced stage cancers. Conclusions This large series of surveys suggest that there are two distinct biological plausibilities in the development of gastric stump carcinoma: (1) it develops in a shorter time interval of 10 years or less since the original gastrectomy, may come from a higher risk of gastric mucosa after gastrectomy for cancer diseases that highly predisposes to cancer, and (2) it develops during a longer time interval of 20 years or more, may come from gastrectomy-relating mechanisms after gastrectomy for original benign diseases.Keywords
This publication has 37 references indexed in Scilit:
- Gastric cancer treated in 1991 in Japan: data analysis of nationwide registryGastric Cancer, 2006
- Clinical study to identify specific characteristics of cancer newly developed in the remnant stomachGastric Cancer, 2002
- Cancer occurrence in a cohort of patients surgically treated for peptic ulcer.Gut, 1991
- Gastric cancer after gastrectomyInternational Journal of Cancer, 1988
- Stomach Cancer after Partial Gastrectomy for Benign Ulcer DiseaseThe New England Journal of Medicine, 1988
- The Risk of Gastric Carcinoma after Surgical Treatment for Benign Ulcer DiseaseThe New England Journal of Medicine, 1983
- Risk of gastric cancer after Billroth II resection for duodenal ulcerBritish Journal of Surgery, 1983
- Causes and clinical significance of gastritis following Billroth II resection for duodenal ulcerBritish Journal of Surgery, 1983
- Late Mortality after Surgery for Peptic UlcerThe New England Journal of Medicine, 1982
- Cancer Development in the Gastric Stump after Partial Gastrectomy for Ulcer^;Annals of Surgery, 1956