Surgical Resection of Remnant Gastric Cancer Following Distal Gastrectomy: A Retrospective Clinicopathological Study

• Published in: Annals of surgical oncology 2016-02, Vol.23 (2), p.511-521
• Main Authors: Takahashi, Masashi, Takeuchi, Hiroya, Tsuwano, Shinichi, Nakamura, Rieko, Takahashi, Tsunehiro, Wada, Norihito, Kawakubo, Hirofumi, Saikawa, Yoshiro, Kitagawa, Yuko
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - surgery; Aged; Female; Follow-Up Studies; Gastrectomy - mortality; Gastric Stump - pathology; Gastric Stump - surgery; Gastrointestinal Oncology; Humans; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Oncology; Prognosis; Reconstructive Surgical Procedures; Retrospective Studies; Risk Factors; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgery; Surgical Oncology; Survival Rate; Time Factors
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-015-4678-x

Background Remnant gastric cancer (RGC) is one of the less prevalent gastric cancers. The purpose of this study was to explore the clinicopathological characteristics and results of the operation of RGC following distal gastrectomy. In particular, we examined factors related to prognosis. Methods Between January 1970 and December 2012, 122 patients with RGC following distal gastrectomy underwent further surgery and were analyzed retrospectively. Results Initial gastric diseases included benign (49 patients, 40.2 %) and malignant diseases (73 patients, 59.8 %). Reconstructions by initial surgery included Billroth I (80 patients, 65.6 %) and Billroth II (42 patients, 34.4 %). Tumors were located at anastomotic (44 patients, 36.1 %) and nonanastomotic sites (78 patients, 63.9 %). There were 59 patients (48.4 %) classified with pathological (p) stage I, 19 as p stage II (15.6 %), 22 as p stage III (18.0 %), and 22 (18.0 %) as p stage IV. A total of 100 patients (82.0 %) underwent curative resection, and 22 underwent noncurative resection. The number of cases of postoperative morbidity, 90-day mortality, and adjuvant chemotherapy were 23 (18.9 %), 3 (2.5 %), and 20 (16.4 %), respectively. Univariate and multivariate analyses were performed to identify the prognostic factors of RGC. Multivariate analysis revealed historical periods, pathological venous invasion, curative resection, and postoperative morbidity to be independent prognostic factors. Conclusions The prognosis of patients with RGC can be improved by aggressively performing curative resection without causing complications.