CLINICOPATHOLOGICAL 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

Background. This study evaluated the prognosis of patients with carcin oma in the gastric remnant stump after distal gastrectomy for benign d isease (stump cancer). Methods. Twenty patients with resected stump ca ncer were studied and compared with 266 patients with resected primary cancer in the upper third of the stomach (primary cancer). Results. T he percentages of lymph nodes with metastases located at the lesser cu rvature 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 meta stases at jejunal mesentery near anastomotic site were found in 2 of 2 0 (10.0%). 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 o f recurrence between patients with curatively resected primary cancer and those with stump cancer. The percentages of peritoneal and hematog enic metastases, respectively, were 40.6% and 31.3% in primary cancer and 0% and 83.3% in stump cancers. 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 lo-cated at diff erent places from those associated with primary cancer. Even when cura tive surgery is performed in patients with stump cancer, it is importa nt to follow up patients and check for,possible metastasis to the live r.