GASTRIC STUMP CANCER - DIAGNOSIS, OPERATI VE PROCEDURE, AND PROGNOSIS

The results of a retrospective analysis of cases of gastric stump canc er are reported. Among 298 gastric carcinomas treated between 1. 1. 19 86 and 1. 3. 1994, we found 28 (9.5%) cases of gastric stump cancer. G astric carcinoma showed a male preponderance, with a male:female ratio of ca. 4:1. Two thirds of the patients were older than 70 years at th e time of diagnosis. In 27 of 28 patients the original operation perfo rmed was a Billroth II resection without Braun's enteroanastomosis. Th e mean time lag before the development of gastric stump cancer was sig nificantly shorter in the group of patients older than 45 years at the time of first operation (n=16) than in patients 45 years or younger ( n=12, P=0.03). Endoscopy with biopsy and endosonography were highly re liable diagnostic instruments. The capability of CT for recognizing ly mphatic metastasis is poor (42.1% sensitivity). The main risk factors for the development of gastric stump cancer, according to our data, ar e male sex, Billroth II resection for first reconstruction, age over 4 5 years at first operation, and gastric ulcer as reason for the origin al gastric resection. The cost benefit ratio and timing of endoscopic screening of partially gastrectomized patients are discussed.