Clinicopathologic differences between carcinoma in the gastric remnant stump after distal partial gastrectomy for benign gastroduodenal lesions and primary carcinoma in the upper third of the stomach

Abstract

Background. This study evaluated the prognosis of patients with carcinoma in the gastric remnant stump after distal gastrectomy for benign disease (stump cancer). Methods. Twenty patients with resected stump cancer were studied and compared with 266 patients with resected primary cancer in the upper third of the stomach (primary cancer). Results. The percentages of lymph nodes with metastases located at the lesser curvature and the left gastric artery, respectively, were 50.0% and 25.2% in patients with primary cancer and 15.0% and 5.0% in patients with stump cancer. In patients with remnant gastric cancer, lymph node metastases at jejunal mesentery near anastomotic site were found in 2 of 20 (10.0%). Conclusion. The lymph flow from the remnant stomach seems to be changed by the initial operation, and as a result, in stump cancer, metastatic lymph nodes are located at different places from those associated with primary cancer. Even when curative surgery is performed in patients with stump cancer, it is important to follow up patients and check for possible metastasis to the liver. The 5‐year survival rates were 62.1% and 52.5% for patients with curatively resected primary cancer (n = 203) and stump cancer (n = 17), respectively, and there was no statistical difference between the two groups. There was a distinct difference in terms of patterns of recurrence between patients with curatively resected primary cancer and those with stump cancer. The percentages of peritoneal and hematogenic metastases, respectively, were 40.6% and 31.3% in primary cancer and 0% and 83.3% in stump cancers.

Does remnant gastric cancer really differ from primary gastric cancer? A systematic review of the literature by the Task Force of Japanese Gastric Cancer Association

“…Thirty-eight studies were given an A score, and 68 studies were given a B score. Finally, we conducted a publication-based meta-analysis using 20 studies that compared the 5-year survival rates between RGC and PGC [3,6,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. In addition, eight studies included data on TNM staging along with the survival data [3,6,13,14,16,17,23,29].…”

“…Lymph node involvement in the jejunal mesentery is a phenomenon peculiar to the RGC after Billroth II reconstruction, with the reported incidence ranging from 7.0 % to 46.8 % [3,6,14,15,26,[51][52][53][54][55][56] (Table 4). Several authors have reported relatively high incidences of lymph node metastases at the splenic hilum in patients with RGC [15,50,51,55].…”

“…Several authors have reported relatively high incidences of lymph node metastases at the splenic hilum in patients with RGC [15,50,51,55]. The preceding lymph node dissection possibly increased the lymphatic flow from the remnant stomach to these nodes.…”

Effects of initial disease status on lymph flow following gastrectomy in cases of carcinoma in the remnant stomach

“…Nevertheless, most studies of lymphatic flow have investigated group B patients. Indeed, no previous study has reported the changes in lymphatic flow in patients in group M, or the optimal range for lymph node dissection [4,8,9]. This study aimed to compare the regions of lymph node metastases and lymphatic flow between cases in group B and in group M.…”

“…In cases of CRS, it appears that changes in lymphatic flow can occur as consequences of lymph node dissection, vascular dissection, anastomosis, and gastrointestinal adhesions from the initial surgery [8,9]. For example, metastasis to the mesojejunal lymph nodes has been reported after Billroth II (B-II) reconstruction, and changes to lymphatic flow due to gastrointestinal anastomosis have been observed [4,10].…”