Gastric stump cancer – unicentric analysis of 7 patients
Authors:
T. Jínek 1; L. Adamčík 1; M. Duda 1,2; M. Škrovina 1,3
Authors place of work:
Chirurgické oddělení Nemocnice Nový Jičín, a. s., Centrum vysoce specializované onkologické péče pro dospělé Nový Jičín
primář: MUDr. M. Škrovina, Ph. D.
1; II. chirurgická klinika LF UP Olomouc
přednosta: prof. MUDr. P. Bachleda, CSc.
2; I. chirurgická klinika LF UP Olomouc
přednosta: prof. MUDr. Č. Neoral, CSc.
3
Published in the journal:
Rozhl. Chir., 2015, roč. 94, č. 9, s. 362-366.
Category:
Original articles
Summary
Introduction:
Gastric stump cancer accounts for 1−4% of all gastric carcinomas. Originally this term included patients who previously underwent surgery due to peptic ulcer disease but today gastric stump cancer also includes patients diagnosed some time after primary gastric resection due to gastric cancer. The incidence is increasing. Gastric stump cancer is associated with poor prognosis and its reported resecability is around 40%.
Methods:
We retrospectively analyzed the data of 7 patients with a preoperatively histologically confirmed stump cancer who had been operated at the Department of Surgery at Nový Jičín Hospital during 2006−2014.
Results:
We operated 5 men and 2 women with the median age of 70 years (55−80). The primary surgical resection in all our patients was BII gastric resection due to peptic ulcer disease, and GSC had evolved within a median of 38 years (32−46) after primary intervention. None of the patients had been regularly screened by endoscopy following primary surgery. We performed five curative resections (four total gastrectomies, one subtotal gastrectomy). Our resecability rate was 71%. In two cases, only explorative laparotomy was performed due to generalisation of the malignancy. Two patients from the resected group died after 30 and 34 months due to progression of their disease; the other three patients are still alive after 17, 19 and 88 months.
Conclusion:
Gastric stump cancer is a malignancy often diagnosed in its late stages. Regural endoscopic screening after primary gastric resection for benign disease can lead to diagnosis at an earlier stage, thereby improving the resection rate and overall survival. This also applies to long-term follow-up of patients with primary subtotal gastrectomy for cancer. Lymphatic metastasizing of the carcinoma can often be different due to the previous surgical intervention and altered anatomy. This must be taken into account during operations.
Key words:
gastric stump cancer – surgical treatment – endoscopic screening
Zdroje
1. Sinning C, Schaefer N, Standop J, et al. Gastric stump carcinoma – epidemiology and current concepts in pathogenesis and treatment. Eur J Surg Oncol 2007;33:133−9.
2. Lagergren J, Lindam A, Mason RM. Gastric stump cancer after distal gastrectomy for benign gastric ulcer in a population-based study. Int J Cancer 2012;131:1048−52.
3. Thorban S, Böttcher K, Etter M, et al. Prognostic factors in gastric stump carcinoma. Ann Surg 2000;231:188−94.
4. Viste A, Bjørnestad E, Opheim P, et al. Risk of carcinoma following gastric operations for benign disease. A historical cohort study of 3470 patients. Lancet 1986;2:502−5.
5. Balfour DC. Factors influencing the life expectency of patients operated on for gastric ulcer. Ann Surg 1922;76:405−8.
6. Ohashi M, Katai H, Fukagawa T, et al. Cancer of the gastric stump following distal gastrectomy for cancer. Br J Surg 2007;94:92−5.
7. Nozaki I, Nasu J, Kubo Y, et al. Risk factors for metachronous gastric cancer in the remnant stomach after early cancer surgery. World J Surg 2010;34:1548−54.
8. Tanigawa N, Nomura E, Lee SW, et al. Society for the Study of Postoperative Morbidity after Gastrectomy. Current state of gastric stump carcinoma in Japan: based on the results of a nationwide survey. World J Surg 2010;34:1540−7.
9. Chen L, Tian H, Chen J, et al. Surgical management of gastric stump cancer: a report of 37 cases. J Zhejiang Univ Sci B 2005;6:38−42.
10. Nakayoshi T, Tajiri H, Matsuda K, et al. Magnifying endoscopy combined with narrow band imaging system for early gastric cancer: correlation of vascular pattern with histopathology. Endoscopy 2004;36:1080−4.
11. Newman E, Brennan MF, Hochwald SN, et al. Gastric remnant carcinoma: just another proximal gastric cancer or a unique entity? Am J Surg 1997;173:292−7.
12. Krýsl I. Karcinom pahýlu žaludku po resekci pro peptický vřed. Rozhl Chir 1976;55:396−8.
13. Park JH, Lee JH, Rhee PL, et al. Endoscopic Screening for Remnant Gastric Cancer: Points to be Considered. Gut Liver 2007;1:22−6.
14. Komatsu S, Ichikawa D, Okamoto K, et al. Differences of the lymphatic distribution and surgical outcomes between remnant gastric cancers and primary proximal gastric cancers. J Gastrointest Surg 2012;16:503−8.
15. Chen CN, Lee WJ, Lee PH, et al. Clinicopathologic characteristics and prognosis of gastric stump cancer. J Clin Gastroenterol 1996;23:251−5.
16. Kwon IG, Cho I, Guner A, et al. Minimally invasive surgery for remnant gastric cancer: a comparison with open surgery. Surg Endosc 2014;28:2452−8.
17. Takenaka R, Kawahara Y, Okada H, et al. Endoscopic submucosal dissection for cancers of the remnant stomach after distal gastrectomy. Gastrointest Endosc 2008;67:359−63.
18. Hirasaki S, Kanzaki H, Matsubara M, et al. Treatment of gastric remnant cancer post distal gastrectomy by endoscopic submucosal dissection using an insulation-tipped diathermic knife. World J Gastroenterol 2008;14:2550−5.
19. Lin YS, Chen MJ, Shih SC, et al. Management of helicobacter pylori infection after gastric surgery. World J Gastroenterol 2014;20:5274−82.
20. Takeno S, Hashimoto T, Maki K, et al. Gastric cancer arising from the remnant stomach after distal gastrectomy: a review. World J Gastroenterol 2014;20:13734−40.
21. Geboes K, Rutgeerts P, Broeckaert L, et al. Histologic appearances of endoscopic gastric mucosal biopsies 10-20 years after partial gastrectomy. Ann Surg 1980;192:179−82.
22. Costa-Pinho A, Pinto-de-Sousa J, Barbosa J, etl al. Gastric stump cancer: more than just another proximal gastric cancer and demanding a more suitable TNM staging system. Biomed Res Int 2013; doi: 10.1155/2013/781896.
23. Huang H, Wang W, Chen Z, et al. Prognostic factors and survival in patients with gastric stump cancer. World J Gastroenterol 2015;21:1865−71.
24. Tanigawa N, Nomura E, Niki M, et al. Clinical study to identify specific characteristics of cancer newly developed in the remnant stomach. Gastric Cancer 2002;5:23−8.
25. Greene FL. Management of gastric remnant carcinoma based on the results of a 15-year endoscopic screening program. Ann Surg 1996;223:701−6.
26. Xiong JJ, Altaf K, Javed MA, et al. Roux-en-Y versus Billroth I reconstruction after distal gastrectomy for gastric cancer: a meta-analysis. World J Gastroenterol 2013;19:1124−34.
27. Komatsu S, Ichikawa D, Okamoto K, et al. Differences of the lymphatic distribution and surgical outcomes between remnant gastric cancers and primary proximal gastric cancers. J Gastrointest Surg 2012;16:503−8.
28. Han SL, Hua YW, Wang CH, et al. Metastatic pattern of lymph node and surgery for gastric stump cancer. J Surg Oncol 2003;82:241−6.
29. Li F, Zhang R, Liang H, et al. The pattern of lymph node metastasis and the suitability of 7th UICC N stage in predicting prognosis of remnant gastric cancer. J Cancer Res Clin Oncol 2012;138:111−7.
30. Kunisaki C, Shimada H, Nomura M, et al. Lymph node dissection in surgical treatment for remnant stomach cancer. Hepatogastroenterology 2002;49:580−4.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2015 Číslo 9
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole vs. Tramadol in Postoperative Analgesia
- Spasmolytic Effect of Metamizole
Najčítanejšie v tomto čísle
- Surgical options to treat constipation: A brief overview
- Cholecystostomy – an obsolete or relevant treatment?
- Choledochal cyst
- Extraintestinal GIST – case report