Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2019; 11(5): 416-423
Published online May 15, 2019. doi: 10.4251/wjgo.v11.i5.416
Surgical resection of gastric stump cancer following proximal gastrectomy for adenocarcinoma of the esophagogastric junction
Fu-Hai Ma, Li-Yan Xue, Ying-Tai Chen, Wei-Kun Li, Yang Li, Wen-Zhe Kang, Yi-Bin Xie, Yu-Xin Zhong, Quan Xu, Yan-Tao Tian
Fu-Hai Ma, Ying-Tai Chen, Wei-Kun Li, Yang Li, Wen-Zhe Kang, Yi-Bin Xie, Yu-Xin Zhong, Quan Xu, Yan-Tao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Li-Yan Xue, Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Tian YT and Xue LY designed the research; Ma FH, Li WK and Chen YT analyzed the data and wrote the paper; Li Y, Kang WZ, Xie YB, Zhong YX and Xu Q collected the patient’s clinical data.
Supported by National Natural Science Foundation of China, No. 81772642; Beijing Municipal Science and Technology Commission, No. Z161100000116045; and Capital’s Funds for Health Improvement and Research, CFH 2018-2-4022.
Institutional review board statement: This study was approved by the Institutional Review Board of the National Cancer Center Hospital.
Informed consent statement: The need for informed consent was waived due to the retrospective nature of the study, and the data were anonymously analyzed.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yan-Tao Tian, MD, Professor, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing 100021, China. tyt67@163.com
Telephone: +86-10-87787120 Fax: +86-10-87787120
Received: January 23, 2019
Peer-review started: January 23, 2019
First decision: March 14, 2019
Revised: April 1, 2019
Accepted: April 19, 2019
Article in press: April 19, 2019
Published online: May 15, 2019
Processing time: 113 Days and 0.6 Hours
Abstract
BACKGROUND

Proximal gastrectomy (PG) is performed widely as a function-preserving operation for early gastric cancer located in the upper third of the stomach and is an important function-preserving approach for esophagogastric junction (EGJ) adenocarcinoma. The incidence of gastric stump cancer (GSC) after PG is increasing. However, little is known about the GSC following PG because very few studies have been conducted on the disease.

AIM

To clarify clinicopathologic features, perioperative complications, and long-term survival rates after the resection of GSC following PG.

METHODS

Data for patients with GSC following PG for adenocarcinoma of the EGJ diagnosed between January 1998 and December 2016 were retrospectively reviewed. Multivariate analysis was performed to identify factors associated with overall survival (OS). GSC was defined in accordance with the Japanese Gastric Cancer Association.

RESULTS

A total of 35 patients were identified. The median interval between the initial PG and resection of GSC was 4.9 (range 0.7-12) years. In 21 of the 35 patients, the tumor was located in a nonanastomotic site of the gastric stump. Total gastrectomy was performed in 27 patients; the other 8 underwent partial gastrectomy. Postoperative complications occurred in 6 patients (17.1%). The tumor stage according to the depth of tumor invasion was T1 in 6 patients, T2 in 3 patients, T3 in 9 patients, and T4 in 17 patients. Lymph node metastasis was observed in 18 patients. Calculated 1-, 3-, and 5-year OS rates were 86.5%, 62.3%, and 54.2%, respectively. Multivariate analysis showed advanced T stage to be associated with OS.

CONCLUSION

This study reveals the characteristics of GSC following PG for adenocarcinoma of the EGJ and suggests that a surgical approach can lead to a satisfactory outcome.

Keywords: Gastric stump cancer; Proximal gastrectomy; Esophagogastric junction; Distal gastrectomy

Core tip: The clinicopathological characteristics, treatment, and prognosis of gastric stump cancer (GSC) after distal gastrectomy have been well investigated, however, there is limited information on GSC after proximal gastrectomy (PG). We revealed characteristics of GSC in detail using the largest number of patients to date. Our results suggest that surgical approaches can achieve satisfactory outcomes in GSC following PG. The factor associated with OS based on multivariate analysis was advanced T stage and GSC is more likely to be diagnosed at an advanced stage. Thus, endoscopic follow-up of the gastric stump should be conducted to detect GSC at an early stage.