Review
Gastric stump carcinoma – Epidemiology and current concepts in pathogenesis and treatment

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Abstract

Aim

The aim of this article is to review the aetiology, pathology and treatment of gastric stump carcinoma (GSC). GSC is an uncommon tumour; however, the incidence is not declining, so this tumour entity will be encountered in the years to come.

Methods

The electronic literature search was performed in the MEDLINE database to identify relevant studies concerning epidemiology, prognosis, treatment, aetiology and pathology of GSC. The references reported in these studies were used to complete the literature search.

Results

Patients subjected to distal gastric resection have a 4–7-fold increased risk of developing GSC, which is attributed mainly to gastroduodenal reflux. Denervation during partial gastrectomy may also contribute to the risk of developing GSC. Gastroduodenal ulcers were the main reason for partial gastrectomy. Both ulcer locations have an increased risk of developing GSC after 20 years. In GSC, Helicobacter pylori seems not to be an important risk factor, contrary to primary gastric cancer, because gastroduodenal reflux impairs the growth of Helicobacter pylori.

Conclusion

The treatment of choice for GSC should be the total removal of the gastric remnant including at least D2 lymphadenectomy. The pattern of lymph node metastases in GSC may differ from primary gastric cancer, as lymph node metastases have been reported in the jejunal mesentery and the lower mediastinum. Therefore, GSC may require a modified lymphadenectomy to include all important lymph node stations. After radical remnant gastrectomy, GSC has a prognosis not different from primary proximal gastric cancer.

Section snippets

Aim of the article and introduction

Gastric stump carcinoma (GSC) is defined as a carcinoma occurring in the gastric remnant at least 5 years after surgery for benign peptic ulcer disease.1, 2 Despite the fact that conservative medical therapy displaced partial gastrectomy for the treatment of ulcer, the incidence of gastric stump carcinoma is not declining, because of the long latency period.3, 4, 5 This implies that more cases of gastric stump carcinoma will be encountered in the future. In addition, even today there are

Methods

The electronic literature search was conducted in the MEDLINE database. The literature on all topics concerning GSC was reviewed. The references reported in these studies were used to complete the literature search. One main focus of the literature search was studies dealing with the different ways of lymph node metastasation, because of its special relevance for treatment. Furthermore, all studies covering the topics of epidemiology, aetiology, pathology, treatment and prognosis in GSC were

Epidemiology

This rising number of GSC cases and the association to the operated stomach was at first described in the 1950s.9 The proportion of GSC ranges from 1.1% to 7% of all gastric carcinomas.7, 10, 11, 12 In recent years, the incidence of GSC has been increasing, because of the long latency period and the frequent performance of partial gastrectomy in the previous decades.3 In retrospective studies with long follow-up times, an increase in the incidence ratio of gastric stump cancer was detected in

Conclusion

The incidence of GSC has not yet declined because of the long time interval until the development of GSC in the operated stomach; the incidence may even rise in the years to come as surgery was frequently performed until the early 1980's. Several studies reported an increased frequency of gastric stump carcinoma after partial gastrectomy.7, 8 Fifteen to twenty years after distal gastrectomy, the risk of GSC steeply rises and the average latency period until manifestation of carcinoma in the

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