SURGERY FOR GASTRIC REMNANT CARCINOMA FOLLOWING BILLROTH-II GASTRECTOMY

Between January 1983 and December 1995, 31 patients with gastric remna nt carcinoma were operated on 6-45 years after a Billroth II resection for peptic ulcer disease. Total gastrectomy with Roux-en-Y reconstruc tion was performed in all casts. In 16 patients (52%) extended resecti on with removal of one or more adjacent organs was necessary for oncol ogical reasons. In this elderly population with a high incidence of pr e-operative risk factors (55%), most tumours were classified as stage III or IV (45%). Although total gastrectomy should be the surgical opt ion of first choice for gastric remnant carcinoma, it resulted in high levels of post-operative mortality and and morbidity (13% and 35%, re spectively), especially in patients with stage III and IV tumours who underwent resection of are adjacent organ. Despite extended surgery, i f necessary, the recurrence rate after 'curative' surgery is high (8/2 0 patients) and the cumulative disease-free 5-year survival rate was 4 8%. Detection of the tumour at an earlier stage not only limits the ex tent of resection and lowers the complication rate, but also improves survival.