Skip to main content

Some NLM-NCBI services and products are experiencing heavy traffic, which may affect performance and availability. We apologize for the inconvenience and appreciate your patience. For assistance, please contact our Help Desk at info@ncbi.nlm.nih.gov.

Annals of Surgery logoLink to Annals of Surgery
. 1996 Jun;223(6):701–708. doi: 10.1097/00000658-199606000-00008

Management of gastric remnant carcinoma based on the results of a 15-year endoscopic screening program.

F L Greene 1
PMCID: PMC1235215  PMID: 8645043

Abstract

SUMMARY BACKGROUND DATA: Partial gastrectomy for benign peptic ulcer disease is associated with an increased risk of adenocarcinoma of the gastric remnant, especially in patients who are at least 15 years' postgastrectomy. Increasing evidence of mucosal dysplasia is noted on random gastric biopsy and may serve as a histologic marker in the identification of early cancer of the gastric stump. METHODS: From an initial group of 233 patients who underwent gastrectomy for benign peptic ulcer disease between 1960 and 1975, 163 patients began yearly flexible gastroscopy and random mucosal biopsy. Routine histologic studies identified either normal or dysplastic epithelium as well as adenocarcinoma. An average of eight biopsies were taken per endoscopic study. All endoscopic studies were performed by surgical residents under the supervision of one surgical attending. RESULTS: From July 1980 to June 1995, 145 patients completed annual gastroscopy and random biopsy. A total of 2287 endoscopic studies were performed. Fifteen patients were found to have severe dysplasia. Nine (60%) had associated microscopic evidence of adenocarcinoma. Four additional patients had macroscopic adenocarcinoma on endoscopic examination. All 13 patients with cancer were asymptomatic. Six patients continue surveillance who display moderate-to-severe dysplasia alone. The 13 patients with carcinoma underwent completion gastrectomy (R2 nodal dissection) with no evidence of cancer found beyond the gastric wall. These patients averaged 29 years since their original partial gastrectomy. OBJECTIVE: A prospective screening program for gastric remnant cancer was begun to assess the ability to discover early neoplastic changes on random biopsy and to make treatment decisions regarding the efficacy of completion gastrectomy after discovery of carcinoma. CONCLUSIONS: Aggressive annual screening using flexible endoscopy and multiple random biopsy may discover cancer in the gastric remnant and can lead to completion curative gastrectomy in asymptomatic people. Patients who are at least 20 years postpartial gastrectomy for benign disease should be considered for annual endoscopic surveillance.

Full text

PDF
701

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Balfour D. C. FACTORS INFLUENCING THE LIFE EXPECTANCY OF PATIENTS OPERATED ON FOR GASTRIC ULCER. Ann Surg. 1922 Sep;76(3):405–408. doi: 10.1097/00000658-192209000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Caygill C. P., Hill M. J., Kirkham J. S., Northfield T. C. Mortality from gastric cancer following gastric surgery for peptic ulcer. Lancet. 1986 Apr 26;1(8487):929–931. doi: 10.1016/s0140-6736(86)91041-x. [DOI] [PubMed] [Google Scholar]
  3. Elder J. B., Knight T. Surgical suppression of gastric acid secretion. Lessons from long-term follow-up studies. Scand J Gastroenterol Suppl. 1991;188:26–32. doi: 10.3109/00365529109111226. [DOI] [PubMed] [Google Scholar]
  4. Fischer A. B., Graem N., Jensen O. M. Risk of gastric cancer after Billroth II resection for duodenal ulcer. Br J Surg. 1983 Sep;70(9):552–554. doi: 10.1002/bjs.1800700915. [DOI] [PubMed] [Google Scholar]
  5. Greene F. L., Dengler W. C. Gastric remnant cancer following procedures for benign ulcer disease--a twenty-five year review. J S C Med Assoc. 1984 Oct;80(10):495–497. [PubMed] [Google Scholar]
  6. Greene F. L. Discovery of early gastric remnant carcinoma. Results of a 14-year endoscopic screening program. Surg Endosc. 1995 Nov;9(11):1199–1203. doi: 10.1007/BF00210928. [DOI] [PubMed] [Google Scholar]
  7. Greene F. L. Early detection of gastric remnant carcinoma. The role of gastroscopic screening. Arch Surg. 1987 Mar;122(3):300–303. doi: 10.1001/archsurg.1987.01400150054010. [DOI] [PubMed] [Google Scholar]
  8. Greene F. L. Gastroscopic screening of the post-gastrectomy stomach. Relationship of dysplasia to remnant cancer. Am Surg. 1989 Jan;55(1):12–15. [PubMed] [Google Scholar]
  9. Greene F. L. Neoplastic changes in the stomach after gastrectomy. Surg Gynecol Obstet. 1990 Dec;171(6):477–480. [PubMed] [Google Scholar]
  10. HELSINGEN N., HILLESTAD L. Cancer development in the gastric stump after partial gastrectomy for ulcer. Ann Surg. 1956 Feb;143(2):173–179. doi: 10.1097/00000658-195614320-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Lacaine F., Houry S., Huguier M. Stomach cancer after partial gastrectomy for benign ulcer disease. A critical analysis of epidemiological reports. Hepatogastroenterology. 1992 Feb;39(1):4–8. [PubMed] [Google Scholar]
  12. Lawrence M., Shiu M. H. Early gastric cancer. Twenty-eight-year experience. Ann Surg. 1991 Apr;213(4):327–334. doi: 10.1097/00000658-199104000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Lundegårdh G., Adami H. O., Helmick C., Zack M., Meirik O. Stomach cancer after partial gastrectomy for benign ulcer disease. N Engl J Med. 1988 Jul 28;319(4):195–200. doi: 10.1056/NEJM198807283190402. [DOI] [PubMed] [Google Scholar]
  14. Matsukura N., Kawachi T., Sasajima K., Sano T., Sugimura T., Hirota T. Induction of intestinal metaplasia in the stomachs of rats by N-methyl-N'-nitro-N-nitrosoguanidine. J Natl Cancer Inst. 1978 Jul;61(1):141–144. doi: 10.1093/jnci/61.1.141. [DOI] [PubMed] [Google Scholar]
  15. Morson B. C., Sobin L. H., Grundmann E., Johansen A., Nagayo T., Serck-Hanssen A. Precancerous conditions and epithelial dysplasia in the stomach. J Clin Pathol. 1980 Aug;33(8):711–721. doi: 10.1136/jcp.33.8.711. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Nomura A., Stemmermann G. N., Chyou P. H., Kato I., Perez-Perez G. I., Blaser M. J. Helicobacter pylori infection and gastric carcinoma among Japanese Americans in Hawaii. N Engl J Med. 1991 Oct 17;325(16):1132–1136. doi: 10.1056/NEJM199110173251604. [DOI] [PubMed] [Google Scholar]
  17. Northfield T. C., Hall C. N. Carcinoma of the gastric stump: risks and pathogenesis. Gut. 1990 Nov;31(11):1217–1219. doi: 10.1136/gut.31.11.1217. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Parsonnet J., Friedman G. D., Vandersteen D. P., Chang Y., Vogelman J. H., Orentreich N., Sibley R. K. Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med. 1991 Oct 17;325(16):1127–1131. doi: 10.1056/NEJM199110173251603. [DOI] [PubMed] [Google Scholar]
  19. Pointner R., Wetscher G. J., Gadenstätter M., Bodner E., Hinder R. A. Gastric remnant cancer has a better prognosis than primary gastric cancer. Arch Surg. 1994 Jun;129(6):615–619. doi: 10.1001/archsurg.1994.01420300057008. [DOI] [PubMed] [Google Scholar]
  20. Rugge M., Farinati F., Baffa R., Sonego F., Di Mario F., Leandro G., Valiante F. Gastric epithelial dysplasia in the natural history of gastric cancer: a multicenter prospective follow-up study. Interdisciplinary Group on Gastric Epithelial Dysplasia. Gastroenterology. 1994 Nov;107(5):1288–1296. doi: 10.1016/0016-5085(94)90529-0. [DOI] [PubMed] [Google Scholar]
  21. Savage A., Jones S. Histological appearances of the gastric mucosa 15--27 years after partial gastrectomy. J Clin Pathol. 1979 Feb;32(2):179–186. doi: 10.1136/jcp.32.2.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Schafer L. W., Larson D. E., Melton L. J., 3rd, Higgins J. A., Ilstrup D. M. The risk of gastric carcinoma after surgical treatment for benign ulcer disease. A population-based study in Olmsted County, Minnesota. N Engl J Med. 1983 Nov 17;309(20):1210–1213. doi: 10.1056/NEJM198311173092003. [DOI] [PubMed] [Google Scholar]
  23. Schrumpf E., Serck-Hanssen A., Stadaas J., Aune S., Myren J., Osnes M. Mucosal changes in the gastric stump 20-25 years after partial gastrectomy. Lancet. 1977 Sep 3;2(8036):467–469. doi: 10.1016/s0140-6736(77)91599-9. [DOI] [PubMed] [Google Scholar]
  24. Sowa M., Onoda N., Nakanishi I., Maeda K., Yoshikawa K., Kato Y., Chung Y. S. Early stage carcinoma of the gastric remnant in Japan. Anticancer Res. 1993 Sep-Oct;13(5C):1835–1838. [PubMed] [Google Scholar]
  25. Stalnikowicz R., Benbassat J. Risk of gastric cancer after gastric surgery for benign disorders. Arch Intern Med. 1990 Oct;150(10):2022–2026. [PubMed] [Google Scholar]
  26. Stalsberg H., Taksdal S. Stomach cancer following gastric surgery for benign conditions. Lancet. 1971 Nov 27;2(7735):1175–1177. doi: 10.1016/s0140-6736(71)90489-2. [DOI] [PubMed] [Google Scholar]
  27. Staël von Holstein C., Eriksson S., Hammar E. Role of re-resection in early gastric stump carcinoma. Br J Surg. 1991 Oct;78(10):1238–1241. doi: 10.1002/bjs.1800781029. [DOI] [PubMed] [Google Scholar]
  28. Staël von Holstein C., Eriksson S., Huldt B., Hammar E. Endoscopic screening during 17 years for gastric stump carcinoma. A prospective clinical trial. Scand J Gastroenterol. 1991 Oct;26(10):1020–1026. doi: 10.3109/00365529109003951. [DOI] [PubMed] [Google Scholar]
  29. Tersmette A. C., Goodman S. N., Offerhaus G. J., Tersmette K. W., Giardiello F. M., Vandenbroucke J. P., Tytgat G. N. Multivariate analysis of the risk of stomach cancer after ulcer surgery in an Amsterdam cohort of postgastrectomy patients. Am J Epidemiol. 1991 Jul 1;134(1):14–21. doi: 10.1093/oxfordjournals.aje.a115988. [DOI] [PubMed] [Google Scholar]
  30. Toftgaard C. Gastric cancer after peptic ulcer surgery. A historic prospective cohort investigation. Ann Surg. 1989 Aug;210(2):159–164. doi: 10.1097/00000658-198908000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Yamamoto N., Tokunaga M., Uemura Y., Tanaka S., Shirahama H., Nakamura T., Land C. E., Sato E. Epstein-Barr virus and gastric remnant cancer. Cancer. 1994 Aug 1;74(3):805–809. doi: 10.1002/1097-0142(19940801)74:3<805::aid-cncr2820740304>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES