Endoscopic Surveillance for Gastric Remnant Cancer after Early Cancer Surgery

Background and Study Aims: The aims of this article were to clarify the incidence of gastric remnant cancer after surgery for early gastric cancer, and to develop surveillance programs for patients who have undergone partial gastrectomy in order to detect such lesions at an early stage.
Patients and Methods: A total of 642 patients with partial gastrectomy for early gastric cancer were enrolled in a surveillance program for gastric remnant cancer between 1985 and 1996. In 509 patients, the interval between endoscopic examinations was no more than 2 years.
Results: Among the 509 patients examined periodically, 15 patients were diagnosed as having gastric remnant cancer; in 12 patients, the cancers were detected at an early stage. All gastric remnant cancers were found distant from the site of the anastomosis, and in eight patients the cancers were located on the lesser curvature. The cumulative 5-year prevalence rate was estimated as 2.4 % and the 10-year prevalence rate as 6.1 %. The initial tumors in the patients with gastric remnant cancer were of the microscopically intestinal type, without exception. The interval between the preceding examination and diagnosis was shorter in the patients with early cancer than in those with advanced cancer (P < 0.01).
Conclusions: Periodical surveillance endoscopy for gastric remnant cancer is recommended after surgery for early gastric cancer, particularly in patients whose cancers are of the intestinal type. The examinations can be repeated at 2 - 3-year intervals, and special attention should be given to the lesser curvature away from the anastomotic site.

References

• 1 Japanese G astric. Japanese classification of gastric carcinoma. 2nd English ed.  Gastric Cancer. 1998;  1 10-24
• 2 Pertl A, Jagoditsch M, Jatzko G R. et al . Long-term results of early gastric cancer accomplished in a European institute by Japanese-type radical resection.  Gastric Cancer. 1999;  2 115-121
• 3 Oliveira F J, Ferrao H, Furtado E. et al . Early gastric cancer: report of 58 cases.  Gastric Cancer. 1998;  1 51-56
• 4 Longo W E, Zucker K A, Zdon M J, Modlin I. Detection of early gastric cancer in an aggressive endoscopic unit.  Am Surg. 1989;  55 100-104
• 5 Hosokawa O, Tsuda S, Kidani E. et al . Diagnosis of gastric cancer up to three years after negative upper gastrointestinal endoscopy.  Endoscopy. 1998;  30 669-674
• 6 Kaizaki Y, Sakurai S, Chong J M, Fukayama M. Atrophic gastritis, Epstein-Barr virus infection, and Epstein-Barr virus-associated gastric carcinoma.  Gastric Cancer. 1999;  2 101-108
• 7 Domellof L, Reddy B S, Weinbeurger J H. Microflora and deconjugation of bile acids in alkaline reflux after partial gastrectomy.  Am J Surg. 1980;  140 291-295
• 8 Lacaine F, Houry S, Hufuier M. Stomach cancer after partial gastrectomy for benign ulcer disease: a critical analysis of epidemiological reports.  Hepatogastroenterology. 1992;  39 4-8
• 9 Fineberg H V, Pearlman L A. Surgical treatment of peptic ulcer in the United States: trends before and after the introduction of cimetidine.  Lancet. 1981;  i 1305-1307
• 10 Jameson G G. Current status of indications of surgery in peptic ulcer disease.  World J Surg. 2000;  24 256-258
• 11 Gouzi J L, Huguier M, Fagniez P L. et al . Total versus subtotal gastrectomy for adenocarcinoma of the gastric antrum: a French prospective controlled study.  Ann Surg. 1989;  209 162-166
• 12 Harrison L E, Karpeh M S, Brennan M F. Total gastrectomy is not necessary for proximal gastric cancer.  Surgery. 1998;  123 127-130
• 13 Bucholtz T W, Welch C E, Malt R A. Clinical correlates of resectability and survival in gastric carcinoma.  Ann Surg. 1978;  188 711-715
• 14 Sasako M, Maruyama K, Kinoshita T, Okabayashi K. Surgical treatment of carcinoma of the gastric stump.  Br J Surg. 1991;  78 822-824
• 15 Furukawa H, Iwanaga T, Hiratsuka M. et al . Gastric remnant cancer as a metachronous multiple lesion.  Br J Surg. 1993;  80 54-56
• 16 Kaneko K, Kondo H, Saito K. et al . Early gastric stump cancer following distal gastrectomy.  Gut. 1998;  43 342-344
• 17 Baas I O, van Rees B P, Musler A. et al . Helicobacter pylori and Epstein-Barr infection and the p53 tumour suppressor pathway in gastric stump cancer compared with carcinoma in the non-operated stomach.  J Clin Pathol. 1998;  51 662-666
• 18 Hosokawa O, Watanabe K, Hattori M. et al . Detection of gastric cancer by repeated endoscopy within a short time after negative examination.  Endoscopy. 2001;  33 301-305
• 19 Isozaki H, Okajima K, Hu X. et al . Multiple early gastric carcinoma.  Cancer. 1996;  78 2078-2086
• 20 Kitamura K, Yamaguchi T, Okamoto K. et al . Clinicopathological feature of synchronous multifocal early gastric cancers.  Anticancer Res. 1997;  17 643-646