EARLY GASTRIC-CANCER IN THE REMNANT STOMACH

BACKGROUND/AIMS:Early gastric cancer in the remnant stomach is rare. P eriodical endoscopic examinations are mandatory for patients with part ial gastrectomy for a good prognosis. Our goal is to improve the surgi cal management of gastric cancer in the remnant stomach. We have retro spectively investigated a total of 15 rare cases of early gastric canc er after partial gastrectomy. METHODOLOGY: From 1976 to 1994, a total of 2,102 cases of gastric cancer were resected in our Department. Amon g these resected cases, 845 cases were histologically diagnosed as hav ing early gastric cancer of the stomach. Of these, 15 patients had pre viously undergone a partial gastric resection. The time interval betwe en the initial partial gastrectomy and the second resection of the rem nant stomach, was more than 10 years for 8 patients (Group 1) and less than 10 years for 7 patients (Group 2). Here we investigate these rar e cases of remnant early gastric cancer. RESULTS: The incidence of ear ly gastric cancer in the remnant stomach was 1.8% (15/845). The cancer location in the remnant stomach was around the stoma and suture line in 75% of Group 1 and in 28.6% of Group 2. The incidence rate of mucos al cancer (m-cancer) was 81.5% for Group 1, and 14.3% for Group 2. Tot al gastrectomy was selected for 37.5% of Group 1, and for 100% of Grou p 2. No lymph node metastasis was discovered in both groups. The posto perative mortality was zero in both groups. One patient from Group 2, later died of liver metastasis 2 years after the second total gastrect omy, while the other 9 patients continued to live for more than 5 year s with no gastric cancer recurrence to date. CONCLUSIONS: The outcome for patients with gastric cancer in the remnant stomach is generally c onsidered poor. However, the outcome of early gastric cancer in the re mnant stomach was good without major postoperative complications. Ther efore, to improve surgical management of remnant-stump gastric cancer, early diagnosis is most important, using periodic endoscopic follow-u p examinations, especially around the stoma. When mucosal cancer aroun d the stoma is diagnosed, subtotal gastrectomy can be selected even in gastrectomized patient for a good prognosis.