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Gastric Remnant Carcinoma

Romeo Giuli MD, resident.
School of General and Emergency Surgery.
University of Siena.   Italy.

July 2002.     Review Article.

Tanigawa et al classify cancer in the remnant stomach into three categories: 1) cancer newly developed in the remnant stomach, 2) cancer remaining in the remnant stomach at the initial gastric surgery, 3) and recurrent cancer in the remnant stomach.

Cancer newly developed in the remnant stomach after partial gastrectomy is worthy of attention not only because it is a typical model of carcinogenesis but also from the aspect of cancer diagnosis.
In this study the mean time interval between the initial surgery and surgery for cancer of the remnant stomach was 25,8 years for patients with CRS with previous benign gastric lesions, and 10,6 years for those with previous gastric cancer.
CRS was frequently detected at an early stage in the patients with a previous cancer, and in the patients who had undergone reconstruction by Billroth I method (regardless of the primary nature of the disease).
Cancers with differentiated histology developed more frequently in the patients who had undergone the initial surgery for cancer disease.

Long term survival results after the second surgery clearly demonstrated that surgical treatment for CRS was as effective as that for primary cancer in the upper stomach ( PUC ). The 5 year cumulative survival rate was 56% for the patients with CRS and 53% for those with PUC in whom curative surgery was achieved. In addition it was confirmed that new lymphatic drainage into the lower mediastinum or the jejunal mesentery had developed after the initial gastric surgery.
Therefore these findings suggested that patients with CRS and those with PUC should be treated similarly, although findings of a high incidence of lymph node metastasis to the lower mediastinum and /or the to the jejunal mesentery in the CRS patients should be taken into consideration ( 1 ).

Newman et al. agree that the outcome following resection of Gastric Remnant Carcinoma is no different from that of other primary proximal gastric cancers of the same stage.
Every effort should be made to perform a curative resection, as this is a significant predictor of outcome ( 2 ).

Kondo suggests that recently the population at risk of gastric stump carcinoma for benign disease has been diminishing significantly, and the incidence of gastric stump carcinoma after surgery for malignant disease has been increasing ( 3 ).


1) Nobuhiko Tanigawa et al. Clinical study to identify specific characteristic of cancer newly developed in the remnant stomach. Gastric Cancer ( 2002 ) 5: 23-28.

2) Elliot Newman, MF Brennan et al. Gastric Remnant Carcinoma : just another proximal gastric cancer or a unique entity ? Am J Surg 1997; 173: 292-297.

3) Ken Kondo. Duodenogastric reflux and gastric stump carcinoma. Gastric Cancer 2002, 5: 16-22.

4) Takeda J et al. Early Gastric Cancer in the remnant stomach. Hepatogastroenterology, 1998; 45: 1907-11.

5) Suzuki S et al. Tumor recurrence in patients with early gastric cancer: a clinicopathological evaluation. J Exp Clin Cancer Res 1998; 17: 187-191.

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