Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jun 14, 2012; 18(22): 2832-2836
Published online Jun 14, 2012. doi: 10.3748/wjg.v18.i22.2832
Progression of remnant gastric cancer is associated with duration of follow-up following distal gastrectomy
Shuhei Komatsu, Daisuke Ichikawa, Kazuma Okamoto, Daito Ikoma, Masahiro Tsujiura, Yukihisa Nishimura, Yasutoshi Murayama, Atsushi Shiozaki, Hisashi Ikoma, Yoshiaki Kuriu, Masayoshi Nakanishi, Hitoshi Fujiwara, Toshiya Ochiai, Yukihito Kokuba, Eigo Otsuji
Shuhei Komatsu, Daisuke Ichikawa, Kazuma Okamoto, Daito Ikoma, Masahiro Tsujiura, Yukihisa Nishimura, Yasutoshi Murayama, Atsushi Shiozaki, Hisashi Ikoma, Yoshiaki Kuriu, Masayoshi Nakanishi, Hitoshi Fujiwara, Toshiya Ochiai, Yukihito Kokuba, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
Author contributions: Komatsu S, Ichikawa D, Okamoto K, Murayama Y, Shiozaki A, Ikoma H, Kuriu Y, Nakanishi M, Fujiwara H, Ochiai T, Kokuba Y and Otsuji E performed research; Komatsu S, Ikoma D, Tsujiura M and Nishimura Y analyzed the data; and Komatsu S wrote the paper.
Correspondence to: Daisuke Ichikawa, MD, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. ichikawa@koto.kpu-m.ac.jp
Telephone: +81-75-2515527 Fax: +81-75-2515522
Received: June 29, 2011
Revised: September 18, 2011
Accepted: October 21, 2011
Published online: June 14, 2012
Abstract

AIM: To re-evaluate the recent clinicopathological features of remnant gastric cancer (RGC) and to develop desirable surveillance programs.

METHODS: Between 1997 and 2008, 1149 patients underwent gastrectomy for gastric cancer at the Department of Digestive Surgery, Kyoto Prefectural University of Medicine, Japan. Of these, 33 patients underwent gastrectomy with lymphadenectomy for RGC. Regarding the initial gastric disease, there were 19 patients with benign disease and 14 patients with gastric cancer. The hospital records of these patients were reviewed retrospectively.

RESULTS: Concerning the initial gastric disease, the RGC group following gastric cancer had a shorter interval [P < 0.05; gastric cancer vs benign disease: 12 (2-22) vs 30 (4-51) years] and were more frequently reconstructed by Billroth-I procedure than those following benign lesions (P < 0.001). Regarding reconstruction, RGC following Billroth-II reconstruction showed a longer interval between surgical procedures [P < 0.001; Billroth-II vs Billroth-I: 32 (5-51) vs 12 (2-36) years] and tumors were more frequently associated with benign disease (P < 0.001) than those following Billroth-I reconstruction. In tumor location of RGC, after Billroth-I reconstruction, RGC occurred more frequently near the suture line and remnant gastric wall. After Billroth-II reconstruction, RGC occurred more frequently at the anastomotic site. The duration of follow-up was significantly associated with the stage of RGC (P < 0.05). Patients diagnosed with early stage RGC such as stage I-II tended to have been followed up almost every second year.

CONCLUSION: Meticulous follow-up examination and early detection of RGC might lead to a better prognosis. Based on the initial gastric disease and the procedure of reconstruction, an appropriate follow-up interval and programs might enable early detection of RGC.

Keywords: Remnant gastric cancer; Surveillance; Follow-up; Reconstruction; Distal gastrectomy