Current status in remnant gastric cancer after distal gastrectomy

Table 1 Initial reconstruction, interval, and location of remnant gastric cancer based on primary disease

Ref.	Primary disease	No. of patients	Initial reconstruction (B-I/B-II/R-Y)	Interval (yr)	Location (Stomal/non-stomal)
Tanigawa et al[8] 2002	Benign	20	7/13	25.8	8/12
	Cancer	27	18/9	10.6	3/24
An et al[22] 2007	Benign	25	-	28.6	16/9
	Cancer	13	-	18.8	7/6
Ohashi et al[23] 2007	Cancer	108	71/281	7.5	14/94
Schaefer et al[24] 2007	Benign	19	1/18	34.0	11/8
Ahn et al[25] 2008	Benign	13	0/13	32.4	12/1
	Cancer	45	6/381	6.8	23/21
Firat et al[26] 2009	Benign	26	0/26	32.0	16/10
Ojima et al[27] 2010	Benign	17	12/5	22.0	8/9
	Cancer	21	16/5	9.0	2/19
Mezhir et al[3] 2011	Benign	105	B-II: 97	32.0	72/33
Komatsu et al[28] 2012	Benign	19	4/15	30.0	9/10
	Cancer	14	12/11	12.0	2/12
Li et al[29] 2013	Benign	88	28/60	32.1	55/33
	Cancer	24	14/10	16.8	9/15
Tokunaga et al[30] 2013	Benign	89	23/66	31.0	46/43
	Cancer	78	59/171	9.4	13/65
Leo et al[31] 2014	Benign	176	10/167	34.6	71/105

¹Remining cases were reconstructed by Roux-en-Y. Stomal: Anastomotic site, non-stomal: non-anastomotic site. B-I: Billroth-I; B-II: Billroth-II; R-Y: Roux-en-Y.

Table 2 The success rate of Helicobacter pylori eradication therapy in remnant stomach

Ref.	No. of patients	Regimen of eradication	Success rate, n (%)
Matsukura et al[42] 2003	20	Dual therapy	14 (70.0)
		Lansoprazole 60 mg, AMPC 1500 mg for 2 wk
	20	Triple therapy	18 (90.0)
		Lansoprazole 60 mg, AMPC 1500 mg, CAM 800 mg daily for 1 wk
Onoda et al[52] 2005	33	Triple therapy	30 (90.9)
		Rabeprazole 20 mg, AMPC 1500 mg, CAM 800 mg daily for 1 wk
Kim et al[53] 2008	61	Triple therapy	53 (86.9)
		Rabeprazole 20 mg, AMPC 2000 mg, CAM 1000 mg daily for 1 wk

AMPC: Amoxicillin; CAM: Clarithromycin.

Table 3 The incidence of lymph node metastases of remnant gastric cancer and primary proximal gastric cancer in the splenic hilar region, around the splenic artery, in the lower mediastinum, and in the jejunal mesentery

Ref.	No. of patients		Splenic hilar(No. 10)	Splenic artery(No. 11)	Lower mediastinum		Jejunal mesentery lymph node metastases
					No. 110	No. 111
Sasako et al[59] 1991	RGC	52	15.2%	23.5%	-	-	15.2%
	PPGC	656	10.4%	10.4%	-	-	-
Ikeguchi et al[60] 1994	RGC	20	0%	25.0%	-	-	10.0%
	PPGC	266	11.3%	15.4%	-	-	-
Thorban et al[57] 2000	RGC	47	-	-	-	-	31.9%
	PPGC	498	-	-	-	-	-
Tanigawa et al[8] 2002	RGC	32	8.3%	9.1%	-	50.0%	60.0%
	PPGC	310	16.7%	21.7%	-	6.7%	-
Han et al[61] 2003	RGC	67	60.0%	72.3%	-	50.0%	16.7%
	PPGC	-	-	-	-	-	-
Schaefer et al[24] 2007	RGC	19	-	-	-	-	22.2%
	PPGC	194	-	-	-	-	-
Li et al[62] 2012	RGC	83	21.4%	14.2%	33.3%	33.3%	54.5%
	PPGC	300	36.4%	16.7%	13.6%	13.0%	-
Komatsu et al[63] 2012	RGC	33	12.1%	-	-	-	67.0%
	PPGC	207	6.8%	-	-	-	-
Leo et al[31] 2014	RGC	176	10.0%	7.1%	-	-	46.4%
	PPGC	-	-	-	-	-	-

RGC: Remnant gastric cancer; PPGC: Primary proximal gastric cancer.

Table 4 Comparison of operative outcomes between remnant gastric cancer and primary proximal gastric cancer

Ref.	No. of patients		R0 resection rate (%)	Adjacent organ resection rate	Prognosis after curative resection
Thorban et al[57] 2000	RGC	50	85.1	Colon: 19.1%, pancreas: 6.4%, liver: 8.5%	MST: 30.9 mo
	PPGC	516	73.9	Colon: 0%, pancreas: 2.8%, liver: 4.9%	MST: 32.1 mo
Tanigawa et al[8] 2002	RGC	47	68.1	68.1%	5-yr OS: 56%
	PPGC	310	-	-	5-yr OS: 53%
An et al[22] 2007	RGC	38	92.1	-	5-yr OS: 54%
	PPGC	794	86.4	-	5-yr OS: 63%
Schaefer et al[24] 2007	RGC	19	-	Colon: 5.3%, pancreas: 10.5%, liver: 5.3%	5-yr OS: 71%
	PPGC	194	-	-	5-yr OS: 48%
Mezhir et al[3] 2011	RGC	105	60.0	Colon: 10.1%, pancreas or liver: 5.8%	5-yr OS: 53%
	PPGC	2099	-	-	Unknown
Komatsu et al[63] 2012	RGC	33	78.8	Colon: 6.1%, pancreas: 12.2%, liver: 6.1%	Unknown
	PPGC	207	-	Colon: 2.9%, pancreas: 4.3%, liver: 1.9%	Unknown
Tokunaga et al[30] 2013	RGC	167	88.0	-	5-yr OS: 54%
	PPGC	755	93.8	-	5-yr OS: 78%

RGC: Remnant gastric cancer; PPGC: Primary proximal gastric cancer; MST: Median survival time; OS: Overall survival.

Table 5 Clinical outcomes of endoscopic submucosal dissection for remnant gastric cancer n (%)

Ref.	No. of ESD lesions	No. of lesions located on the suture line	En bloc resection rate	Complete resection rate	Complications
					Perforation	Bleeding
Takenaka et al[65] 2008	31	12 (38.7)	30 (96.8)	23 (74.2)	4 (12.9)	0
Hirasaki et al[66] 2008	17	-	17 (100)	14 (82.4)	0	3 (17.6)
Hoteya et al[67] 2010	401	-	-	38 (95.0)	1 (2.5)	2 (5.0)
Lee et al[68] 2010	13	6 (46.2)	13 (100)	11 (84.6)	0	0
Nishide et al[69] 2012	622	29 (46.8)	59 (95.2)	53 (85.5)	11 (17.7)	5 (8.2)
Nonaka et al[70] 2013	94	-	86 (91.5)	77 (81.9)	2 (2.1)	2 (2.1)
Tanaka et al[71] 2014	33	11 (33.3)	33 (100)	31 (93.9)	3 (9.1)	1 (3.0)

¹Including 9 patients of gastric tube cancer after esophagectomy;

²Including 14 patients of gastric tube cancer after esophagectomy. ESD: Endoscopic submucosal dissection.

Table 6 Clinical outcomes of laparoscopic surgery for remnant gastric cancer

Ref.	Type of procedure	No. of patients	Operation time (min)	Blood loss (mL)	Conversion to open surgery	No. of retrieved lymph nodes	Complication rate (%)	5-yr OS (%)
Kim et al[76] 2014	Lap	171	197	-	0%	12.9	23.5	-
	Open	50	149	-	-	-	30.0	-
Kwon et al[77] 2014	Lap	182	266	182	5.6%	8	33.3	100.0
	Open	58	203	193	-	7	44.8	94.9
Nagai et al[78] 2014	Lap	12	362	69	0%	23.7	0.0	77.8
	Open	10	271	746	-	15.9	20.0	72.9
Tsunoda et al[79] 2014	Lap	10	325	55	0%	22	10.0	-
	Open	6	289	893	-	7	33.3	-
Son et al[80] 2015	Lap	17	234	228	47.1%	18.8	35.3	67.0
	Open	17	170	184	-	22.3	29.4	60.3

¹Including 10 cases of distal gastrectomy;

²Including 8 cases of robotic surgery. OS: Overall survival.