Published online Feb 28, 2016. doi: 10.3748/wjg.v22.i8.2424
Peer-review started: May 6, 2015
First decision: August 25, 2015
Revised: November 9, 2015
Accepted: December 12, 2015
Article in press: December 14, 2015
Published online: February 28, 2016
Processing time: 302 Days and 23.8 Hours
Remnant gastric cancer (RGC) and gastric stump cancer after distal gastrectomy (DG) are recognized as the same clinical entity. In this review, the current knowledges as well as the non-settled issues of RGC are presented. Duodenogastric reflux and denervation of the gastric mucosa are considered as the two main factors responsible for the development of RGC after benign disease. On the other hand, some precancerous circumstances which already have existed at the time of initial surgery, such as atrophic gastritis and intestinal metaplasia, are the main factors associated with RGC after gastric cancer. Although eradication of Helicobacter pylori (H. pylori) in remnant stomach is promising, it is still uncertain whether it can reduce the risk of carcinogenesis. Periodic endoscopic surveillance after DG was reported useful in detecting RGC at an early stage, which offers a chance to undergo minimally invasive endoscopic treatment or laparoscopic surgery and leads to an improved prognosis in RGC patients. Future challenges may be expected to elucidate the benefit of eradication of H. pylori in the remnant stomach if it could reduce the risk for RGC, to build an optimal endoscopic surveillance strategy after DG by stratifying the risk for development of RGC, and to develop a specific staging system for RGC for the standardization of the treatment by prospecting the prognosis.
Core tip: There seemed two different categories of remnant gastric cancer. One develops at the stomal area following distal gastrectomy for benign disease after a long latency period, caused by the duodenogastric reflux. The other develops in the remnant stomach following gastric cancer surgery during the follow-up period, correlated with Helicobacter pylori. Early detection and aggressive surgical approach are essential to improve the prognosis. A specific staging system should be necessary to predict the prognosis. Minimally invasive treatments, such as endoscopic or laparoscopic surgery, have been applied recently.