Yonago Acta medica 2000;43:73–80
Clinicopathological Aspects of Gastric Carcinoma in the Remnant Stomach
Masahide Ikeguchi, Shin-ichi Oka and Michio Maeta*
First Department of Surgery and *Department of Fundamental Nursing, Faculty of Medicine, Tottori University, Yonago 683-0826, Japan
The clinicopathological differences between remnant gastric carcinoma (RGC) after partial gastrectomy for benign disease (RGC-BD) and RGC after partial gastrectomy for gastric carcinoma (RGC-GC) were evaluated. The incidences of developing gastric carcinomas in patients more than 10 years after partial gastrectomy for benign disease or for gastric carcinoma were compared with those of developing gastric carcinomas in patients with colorectal carcinoma who were determined to have no malignant disease in the stomach preoperatively. Next, we analyzed the clinicopathological differences among RGC-BD, RGC-GC and primary gastric carcinoma (PGC) in the upper third of the stomach. RGC-BD was detected in 8 of 1,187 (0.7%) patients and RGC-GC was detected in 19 of 764 (2.5%) patients. Among the controls, 7 of 226 (3.1%) patients developed gastric carcinoma. The estimated risk of developing of RGC-BD and RGC-GC were 0.12 and 0.798. No difference was found among 18 patients with RGC-BD, 16 patients with RGC-GC and 229 patients with PGC in terms of patient age, histologic type, tumor size and distribution of tumor stage. The 5-year survival rate for patients with PGC (55%) was not different from that for patients with RGC-BD (43%) or that for patients with RGC-GC (65%). However, the interval between initial operation and detection of RGCs was longer in RGC-BD than in RGC-GC (P=0.004), and RGCs were more frequently detected at the site of anastomosis in patients with RGC-BD (50%) than in patients with RGC-GC (19%, P= 0.057). The incidence of developing RGCs after partial gastrectomy for benign and malignant diseases was low. The histologic type of tumors and tumor stages of RGC-GC were not different from those of RGC-BD; however, RGC-GC developed within a short time and most lesions were at sites remote from the anastomosis. These findings indicate that carcinogenesis of RGC-GC appears to be different from that of RGC-BD.
Key words: partial gastrectomy for benign disease; partial gastrectomy for gastric carcinoma; primary gastric carcinoma in the upper third of the stomach; prognosis; remnant gastric carcinoma
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