Published online May 15, 2019. doi: 10.4251/wjgo.v11.i5.416
Peer-review started: January 23, 2019
First decision: March 14, 2019
Revised: April 1, 2019
Accepted: April 19, 2019
Article in press: April 19, 2019
Published online: May 15, 2019
Proximal gastrectomy (PG) is performed widely as a function-preserving operation for early gastric cancer located in the upper third of the stomach and is an important function-preserving approach for esophagogastric junction (EGJ) adenocarcinoma. The incidence of gastric stump cancer (GSC) after PG is increasing. However, little is known about the GSC following PG because very few studies have been conducted on the disease.
To clarify clinicopathologic features, perioperative complications, and long-term survival rates after the resection of GSC following PG.
Data for patients with GSC following PG for adenocarcinoma of the EGJ diagnosed between January 1998 and December 2016 were retrospectively reviewed. Multivariate analysis was performed to identify factors associated with overall survival (OS). GSC was defined in accordance with the Japanese Gastric Cancer Association.
A total of 35 patients were identified. The median interval between the initial PG and resection of GSC was 4.9 (range 0.7-12) years. In 21 of the 35 patients, the tumor was located in a nonanastomotic site of the gastric stump. Total gastrectomy was performed in 27 patients; the other 8 underwent partial gastrectomy. Postoperative complications occurred in 6 patients (17.1%). The tumor stage according to the depth of tumor invasion was T1 in 6 patients, T2 in 3 patients, T3 in 9 patients, and T4 in 17 patients. Lymph node metastasis was observed in 18 patients. Calculated 1-, 3-, and 5-year OS rates were 86.5%, 62.3%, and 54.2%, respectively. Multivariate analysis showed advanced T stage to be associated with OS.
This study reveals the characteristics of GSC following PG for adenocarcinoma of the EGJ and suggests that a surgical approach can lead to a satisfactory outcome.
Core tip: The clinicopathological characteristics, treatment, and prognosis of gastric stump cancer (GSC) after distal gastrectomy have been well investigated, however, there is limited information on GSC after proximal gastrectomy (PG). We revealed characteristics of GSC in detail using the largest number of patients to date. Our results suggest that surgical approaches can achieve satisfactory outcomes in GSC following PG. The factor associated with OS based on multivariate analysis was advanced T stage and GSC is more likely to be diagnosed at an advanced stage. Thus, endoscopic follow-up of the gastric stump should be conducted to detect GSC at an early stage.