SURGICAL-TREATMENT FOR ADVANCED-CARCINOMA OF THE GASTRIC REMNANT

BACKGROUND/AIMS: Carcinoma of the gastric remnant has increased in rec ent years, but a therapeutic strategy for this disease has not been es tablished. This retrospective study was performed to determine the mos t appropriate surgical procedure for carcinoma of the gastric remnant. METHODOLOGY: A total of 25 patients who underwent operation for advan ced carcinoma of the gastric remnant that had developed after distal g astrectomy (13 for benign gastric diseases, B group; 12 for gastric ca rcinoma, M group) were studied. Clinicopathological features, as well as the status of lymph node metastasis, were investigated in the B and M groups. RESULTS: There were more patients with carcinoma invading o ther organs, stage IV disease, and with N2 or more lymph node metastas is (especially, with a high metastatic rate to lymph nodes along the s plenic artery) in the M group than in the B group. Forty percent of pa tients in the M group were treated by left upper abdominal evisceratio n (LUAE), but only 8% in the B group. The Survival rate (5-year, 46.0% ) of the B group was significantly higher than that (5-year, 11.9%) of the M group. When we compared the survival rate of carcinoma of the g astric remnant with that of primary carcinoma of the upper third of th e stomach, there was no difference between the two groups in the curat ive resection cases. CONCLUSIONS: Almost the same surgical strategy ca n be adopted for the B group as for primary gastric carcinoma. On the other hand, for the M group, a radical surgical procedure, LUAE, shoul d be recommended.