J.Jpn. Surg. Soc.. 91(3): 340-347, 1990

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Original article

A STUDY ON 29 PATIENTS WITH CANCERS OF THE GASTRIC REMNANT
ーA SPECULATION ON A REMNANT CANCER-PROMOTING FACTOR FROM THE ASPECT OF TUMOR LOCATIONー

We reviewed 29 patients who developed carcinomas of the gastric remnant more than 10 years after the initial gastrectomy. The median age was 59 years (29-75), with a male-to-female ratio of 3.8:1. The reason for previous operation was stomach ulcer in 16 patients, chronic gastritis in 2, stomach polyp in 2, duodenal ulcer in 5 and stomach cancer in 4 patients. Regarding the type of the original operations, Billroth's operation I (B-1) was performed for 10 patients, Billroth's II (B-II) for 18 and Roux-en Y operation for one. The site of tumor was classified into three groups, stoma (gastroenterostomy), stump (gastric cut-end except stoma) and others (the site except stoma and stump). The patients reconstructed with B-II developed significantly more carcinomas in the stoma than those reconstructed with B-1, with the incidence of 10/18 and 0/10, respectively (p<0.05). The interval between the initial operation and the second one was significantly longer in patients with stomal cancer than in those with stump cancer (p< 0.05). There were no significant difference in the frequency and degree of histologic change, such as intestinal metaplasia or glandular cystification in noncancerous areas, between the B-I and BII patients. This study surggested that cancers of the gastric remnant, especially those developed in the stoma after B-II were different from the other remnant cancers in terms of carcinogenesis or cancer promotion, and that they were probably induced by duodenogastric reflux to the gastrojejunostomized area.

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