Current State of Gastric Stump Carcinoma in Japan: Based on the Results of a Nationwide Survey

Tanigawa, Nobuhiko; Nomura, Eiji; Sang-Woong Lee; Kaminishi, Michio; Sugiyama, Mitsugu; Aikou, Takashi; Kitajima, Masaki
July 2010
World Journal of Surgery;Jul2010, Vol. 34 Issue 7, p1540
Academic Journal
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. 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. 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. 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.


Related Articles

  • What have we learned from surgical treatment of gastric adenocarcinoma? A comparison of two periods. Potrč, Stojan; Kavalar, Rajko; Hajdinjak, Tine; Horvat, Matjaž; Vidovič, Damjan; Gadžijev51, Eldar // Wiener Klinische Wochenschrift;2004 Supplement 2, Vol. 116, p56 

    In January 1992, a standardized and more radical surgical approach in gastric cancer treatment and a standardized pathohistological workup of specimens was introduced at our institution. The aim of our retrospectively designed study was to compare the results of two consecutive groups of...

  • Pattern of abdominal nodal spread and optimal abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma of the cardia: results of a multicenter study. Fujitani, Kazumasa; Miyashiro, Isao; Mikata, Shoki; Tamura, Shigeyuki; Imamura, Hiroshi; Hara, Johji; Kurokawa, Yukinori; Fujita, Jyunya; Nishikawa, Kazuhiro; Kimura, Yutaka; Takiguchi, Shuji; Mori, Masaki; Doki, Yuichiro // Gastric Cancer;Jul2013, Vol. 16 Issue 3, p301 

    Background: It remains uncertain whether radical lymphadenectomy combined with total gastrectomy actually contributes to long-term survival for Siewert type II adenocarcinoma of the cardia. We identified the pattern of abdominal nodal spread in advanced type II adenocarcinoma and defined the...

  • The impact of abdominal shape index of patients on laparoscopy-assisted distal gastrectomy for early gastric cancer. Ojima, Toshiyasu; Iwahashi, Makoto; Nakamori, Mikihito; Nakamura, Masaki; Takifuji, Katsunari; Katsuda, Masahiro; Iida, Takeshi; Tsuji, Toshiaki; Hayata, Keiji; Yamaue, Hiroki // Langenbeck's Archives of Surgery;Mar2012, Vol. 397 Issue 3, p437 

    Purpose: The aim of this study was to explore the effects of the abdominal shape index on gastric cancer patients' short-term surgical outcomes of laparoscopy-assisted distal gastrectomy (LADG) in both genders. Methods: This retrospective study included 231 consecutive patients with early...

  • Laparoscopic gastrectomy with regional lymph node dissection for upper gastric cancer. Tanimura, Shinya; Higashino, Masayuki; Fukunaga, Yosuke; Osugi, Harushi // Gastric Cancer;Mar2003, Vol. 6 Issue 1, p0064 

    Recently, a minimally invasive operation for gastric malignancies has been developed, and this laparoscopic operation is seen as a technique that will raise quality of life for patients. Previously, we reported this technique, as well as the results of a distal gastrectomy with regional lymph...

  • Significance of isolated tumor cells in lymph nodes among gastric cancer patients. Horstmann, Olaf; Fuuml;zesi, Laszlo; Markus, Peter; Werner, Carola; Becker, Heinz // Journal of Cancer Research & Clinical Oncology;Dec2004, Vol. 130 Issue 12, p733 

    Purpose: To determine the frequency and prognostic impact of isolated tumor cells (ITC) in regional lymph nodes judged to be tumor free in conventional histopathology among gastric cancer patients. Methods: Among 161 patients who underwent gastrectomy and D2-lymphadenectomy, 56 were staged pN0...

  • Trans-vaginal specimen extraction following totally laparoscopic subtotal gastrectomy in early gastric cancer. Sang-Ho Jeong; Young-Joon Lee; Choi, Won J.; Paik, Won Y.; Chi-Young Jeong; Soon-Tae Park; Sang-Kyung Choi; Soon-Chan Hong; Eun-Jung Jung; Young-tae Joo; Woo-Song Ha // Gastric Cancer;Mar2011, Vol. 14 Issue 1, p91 

    Background: Although natural orifice extraction is now widely performed, there have been no reports of this procedure following subtotal gastrectomy for gastric cancer. This report describes trans-vaginal specimen extraction in four patients with early gastric cancer. Methods: The clinical data...

  • Comparison of laparoscopically assisted and open radical distal gastrectomy with extended lymphadenectomy for gastric cancer management. Ziqiang, W.; Feng, Q.; Zhimin, C.; Miao, W.; Lian, Q.; Huaxing, L.; Peiwu, Y. // Surgical Endoscopy;Nov2006, Vol. 20 Issue 11, p1738 

    Background: The feasibility and safety of laparoscopically assisted gastrectomy with extended lymphadenectomy for advanced gastric cancer has rarely been studied. This study aimed to investigate the feasibility, safety, and cancer clearance of laparoscopically assisted distal...

  • Multidetector computed tomography for preoperative identification of left gastric vein location in patients with gastric cancer. Kawasaki, Kentaro; Kanaji, Shingo; Kobayashi, Iwao; Fujita, Tadatoshi; Kominami, Hiroaki; Ueno, Kimihiko; Tsutida, Shinobu; Ohno, Masakazu; Ohsawa, Masato; Fujino, Yasuhiro; Tominaga, Masahiro; Nakamura, Takeshi // Gastric Cancer;Mar2010, Vol. 13 Issue 1, p25 

    The area near the left gastric vein (LGV) is a challenging site at which to perform dissection of the lymph nodes during gastrectomy. Therefore, knowledge of the precise location of the LGV is important. The objective of this study was to examine the usefulness of multidetector computed...

  • Western body mass indices need not compromise outcomes after modified D2 gastrectomy for carcinoma. Barry, Jonathan D.; Blackshaw, Guy R.J.C.; Edwards, Paul; Lewis, Wyn G.; Murphy, Paula; Hodzovic, Ilias; Thompson, Ian W.; Allison, Miles C. // Gastric Cancer;Jun2003, Vol. 6 Issue 2, p80 

    Background. To determine the role of body mass index (BMI) in a Western population on outcomes after modified D2 gastrectomy (preserving pancreas and spleen where possible) for gastric cancer. Methods. Eighty-four consecutive patients undergoing an R0 modified D2 gastrectomy for gastric cancer...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics