Gastric remnant cancer compared with primary proximal gastric cancer

BACKGROUND/AIMS: Recently, detections of early-stage gastric remnant cancer and small proximal gastric cancer are increasing. The aim of this study was to compare pathologic and prognostic data of gastric remnant cancer with those of primary proximal gastric cancer including upper gastric cancer based on a recent 15-year experience at a single institute in Japan. METHODOLOGY: Among 698 patients who underwent gastrectomy for cancer between 1984 and 1998, 15 (2.1%) were patients with gastric remnant cancer. During the same period, 139 patients underwent primary gastrectomy for proximal gastric cancer which included 71 with upper gastric cancer confined to the upper one-third of the stomach. Clinicopathologic findings of gastric remnant cancer were compared with those of proximal gastric cancer. RESULTS: Of 15 gastric remnant cancers, 8 (53%) were stage I tumors. Although gastric remnant cancer and proximal gastric cancer was not different in several clinicopathologic factors, gastric remnant cancer and upper gastric cancer confined to the upper one-third of the stomach was different with regard to the frequency of tumor size > or = 4 cm (60% vs. 32%, p < 0.05), poorly differentiated type (67% vs. 38%, p < 0.05), serosal invasion (40% vs. 11%, p < 0.01), lymph node metastasis (47% vs. 20%, p < 0.05), stage III or IV disease (47% vs. 10%, p < 0.01), and noncurative gastrectomy (20% vs. 1%, p < 0.01). The 5-year survival rate of gastric remnant cancer (69%) was higher than that of proximal gastric cancer (57%) and lower than that of upper gastric cancer (81%), although the differences were not statistically significant. CONCLUSIONS: In our recent series, a half of gastric remnant cancers are stage I tumors. Although gastric remnant cancers are similar to proximal gastric cancers, they are more advanced and their surgical results are less satisfactory when compared with upper gastric cancers confined to the upper one-third of the stomach.     

Overexpression of p53 is not associated with drug resistance of gastric cancers to 5-fluorouracil-based systemic chemotherapy

BACKGROUND/AIMS: Recent in vitro evidence has strongly suggested that most anti-cancer drugs exert their cytotoxic effects via a p53-dependent apoptosis pathway. An intact p53 molecule appears to be a prerequisite for the cancer cells to be susceptible to these drugs. In this study, we specifically examined if overexpression of p53 may confer drug resistance on human gastric cancer. METHODOLOGY: All patients were treated by an empirical HDFL regimen (weekly 24-hour infusion of 5-FU, 2,600 mg/m2 and leucovorin, 300 mg/m2) in a prospective phase II clinical trial. Among them, patients with adequate pre-chemotherapy gastric cancer tissues for immunohistochemical studies were selected for this study. A p53 DO7 monoclonal antibody was used to detect the overexpression of p53. The results were designated as "-" or "+" by the independent interpretation of two pathologists. RESULTS: A total of 30 patients, 18 men and 12 women, with a median age of 61.5 years (range: 32-78 years), were studied. There were 15 responders and 15 non-responders to HDFL chemotherapy. The percentage of p53 overexpression with positive DO7 staining was 20.0% (6 out of 30). There were no significant differences in the pertinent clinicopathologic features between the patients with positive staining of p53 and the patients with negative staining of p53. Three out of 6 (50.0%) patients with positive staining of p53 and 12 out of 24 (50.0%) patients with negative staining of p53 responded to chemotherapy, respectively (p = 1.000 by Fisher's exact test). CONCLUSIONS: Our data suggested that the overexpression of p53 does not predict drug resistance to 5-FU of human gastric cancer.     

Characteristics and prognosis of synchronous multiple early gastric cancer

AIM:To assess the clinicopathologic characteristics,risk factors,and prognosis for synchronous multiple early gastric cancer(SMGC).METHODS:A total of 146 patients with SMGC and1194 patients with single gastric cancer who had undergone gastrectomy between 1989 and 2008 were retrospectively analyzed to determine their clinicopathologic characteristics and postoperative survival.Tumors were classified into groups on the basis of location and histology.Smoking habits were evaluated using the Brinkman index.Clinical and pathological factors were compared using either Fisher’s exact test or Pearson’sχ2test.Logistic regression analysis was performed to identify independent risk factors.Survival rate was calculated using the Kaplan-Meier method.RESULTS:SMGCs accounted for 10.9%of gastric cancer cases and occurred predominantly in elderly male patients with a family history of gastric cancer who were both smokers and drinkers.These tumors were typically macroscopically elevated and histologically differentiated.There were no significant differences between SMGC and single gastric cancer patients with respect to tumor location,tumor size,lymph node metastasis,the number of metastatic lymph nodes,venous invasion,or tumor stage(P=0.052,P=0.347,P=0.595,P=0.805,P=0.559,and P=0.408,respectively).Further,there was no significant difference in postoperative survival between the patient groups(P=0.200).Of the 146SMGC patients,a single patient had remnant cancer.CONCLUSION:A careful preoperative endoscopy is necessary for patients who are at high risk of SMGC,and minimally invasive treatment may be indicated in some cases.     

Metachronous esophageal squamous cell cancer after gastrectomy for gastric cancer

Background

The clinical and biological characteristics of metachronous esophageal squamous cell cancer (ESCC) after gastrectomy for gastric cancer have yet to be sufficiently elucidated. The aim of the present study was to examine carcinogenesis in such patients.

Methods

Subjects comprised 11 patients with metachronous carcinoma in whom ESCC occurred after gastric cancer (metachronous ESCC), 9 patients with simultaneously occurring gastric cancer and ESCC (simultaneous ESCC) and 52 patients with ESCC alone. We investigated the clinicopathological findings and biological properties using p53, p21 and cyclin D1 expression.

Results

The positive rate for the intraepithelial spread of tumor was higher for metachronous ESCC than for simultaneous ESCC (p < 0.05). The number of dysplastic lesions in metachronous ESCC, simultaneous ESCC and ESCC alone was 56, 41 and 44, respectively. The rate of positive p53 expression in dysplasia was significantly higher for metachronous ESCC than for ESCC alone (p = 0.03).

Conclusions

Positive expression of p53 was found in not only the primary tumor, but also intraepithelial neoplasia around the tumor in metachronous ESCC. Chronic gastroesophageal reflux due to gastrectomy may be involved in the process of carcinogenesis in addition to environmental and genetic factors for metachronous ESCC. Further studies of a larger number of patients with metachronous ESCC and a history of gastrectomy are warranted.     

Prognostic and clinical evaluation of patients with T2 gastric cancer

BACKGROUND/AIMS: Little is known about the clinicopathological features of intermediate-stage T2 gastric cancer, defined as tumors invading the muscularis propria or subserosa. METHODOLOGY: Of 808 patients with gastric cancer, 210 patients (25.9%) who underwent gastrectomy for T2 gastric cancer were selected for this retrospective study. The clinicopathologic findings of these patients were analyzed retrospectively from their hospital records. RESULTS: Of all 808 patients with gastric cancer, 73 patients (9.0%) had tumors invading the muscularis propria (mp). The remaining 137 patients (16.9%) had tumors invading the subserosa (ss). Compared with ss gastric cancer, mp gastric cancer was associated with smaller tumor size, an absence of lymphatic spreading, and hematogenous and late recurrence [disease-free interval: 654.5 days (mp) vs. 365.5 days (ss)]. Univariate analysis of cases with curative operations showed that lymphatic invasion, and lymph node metastasis were significant prognostic factors in patients with T2 gastric cancer. Further examination by multivariate analysis demonstrated that pN2 or higher as classified by both the JCGC (Japanese Classification of Gastric Cancer) and the TNM lymph node staging systems was a predictor of poor prognosis. CONCLUSIONS: JCGC and TNM lymph node staging systems were the most reliable prognostic factors for T2 gastric cancer. Close follow-up should be required for patients with stage pN2 or higher gastric cancer. Long-term follow-up should be required for mp cancers, in particular.     

Higher gastric mucin secretion and lower gastric acid output in first-degree relatives of gastric cancer patients

BACKGROUND: Patients infected by Helicobacter pylori who have first-degree relatives with gastric cancer have an 8-fold increased risk of developing gastric cancer themselves. Mucins are high-molecular-weight glycoproteins that play a cardinal role in the protective mechanism of the gastric epithelium. AIM: To study gastric acid and mucin secretion in dyspeptic patients with and without a family history of gastric cancer and H. pylori infection. MATERIALS AND METHODS: Twenty-six dyspeptic patients underwent esophago-gastro-duodenoscopy, gastric biopsies, and acid and mucin secretory tests. The sample was divided by family history of gastric cancer and H. pylori status. RESULTS: Patients who were infected by H. pylori had a significantly higher degree of inflammation than those who were not. H. pylori-positive patients with a positive family history had a lower basal and maximal gastric acid output than infected patients with no family history and noninfected controls, and a higher basal and maximal mucin output than infected patients with no family history. MUC5AC was the major mucin species expressed in gastric juice. CONCLUSIONS: In patients with relatives with gastric cancer, H. pylori infection is associated with a more severe inflammatory reaction consisting of decreased gastric acid secretion and increased mucin secretion.     

粘着斑激酶在胃癌中的表达及临床意义

目的观察粘着斑激酶(FAK)在胃癌及癌旁组织表达的差异,探讨FAK与胃癌临床病理参数的关系。方法应用免疫组化SP法检测61例胃癌组织及其癌旁组织FAK的表达。结果FAK在胃癌及其癌旁组织阳性表达率分别为86.8%(53/61)和75.4%(46/61),差异无显著性(P>0.05);但FAK较强阳性/强阳性(即++/+++)的表达率分别为59%、26.2%,差异有显著性(P<0.05),且其表达水平与胃癌分化程度、浸润深度、淋巴结转移、临床分期呈正相关。结论在胃癌组织中FAK(++/+++)的表达水平较正常组织明显增高,提示FAK参与胃癌的发病,并与胃癌的浸润、转移关系密切。     

Combined resection of the involved organs in T4 gastric cancer

BACKGROUND/AIMS: It remains controversial whether extended surgeries for gastric cancer can improve the postoperative survival rate. This study was designed to evaluate the effectiveness of a combined resection of the involved organs for improving the survival of gastric cancer patients. METHODOLOGY: Of the 1600 patients treated at our Department, from 1969-1993, 231 patients were found to have evidence of adjacent organ spread at laparotomy. Of the 231 patients, 174 underwent a combined resection of the adjacent organs with a gastrectomy due to direct invasion of these organs by the gastric cancer. The clinicopathological characteristics of 231 patients who had adjacent organ spread were compared retrospectively with 495 patients who had no adjacent organ spread. RESULTS: Although the postoperative survival rate of those patients who underwent a gastrectomy with a combined resection of the involved organs was poor, 14 patients survived for 5 years or longer after the surgery. The clinicopathologic factors characteristic of these 14 surviving patients were a lesser extent of lymph node metastasis and high operative curability. CONCLUSIONS: A combined resection of the involved organs with a gastrectomy should be performed when lymph node metastasis is not evident.     

p53 protein expression in resected invasive esophageal cancer

Many studies have reported the increased expression of p53 protein in various human malignancies and its accumulation have been considered an intermediate biomarker in multistage carcinogenesis. This study was designed to evaluate p53 expression by immunohistochemistry using Dako p53, D0-7 monoclonal antibody in 33 resected invasive squamous cell esophageal cancers (SqCC). The relationship between p53 immunoreactivity and clinicopathologic parameters was determined by the Chi-square test and Student's t test. p53 protein overexpression (more then 10% positive staining cancer cells) was found in 15 out of 33 (45%) tumors. Positive test was found in 38% cases in Stage IIA, 57% in Stage IIB, 45% in Stage III and 50% cases in Stage IV. p53 overexpression was observed in 48% of tumors with lymph nodes metastases, and 41% of tumors without lymph nodes metastases. In respect of tumor differentiation, cases graded as G1, G2 and G3 were positive in 50%, 50% and 40%, respectively. Thirteen per cent of patients with p53 protein overexpression and 16% of patients without p53 protein overexpression survived more than 3 years. There was no correlation between p53 overexpression and stage, tumor differentiation, lymph nodes metastases, and patients survival. In conclusion our results showed that p53 overexpression did not correlate with clinicopathologic feature of invasive SqCC of the esophagus and p53 protein overexpression was unsuitable for predicting the outcome of patients after surgical resection.     

Pancreaticoduodenectomy for advanced gastric cancer with pancreaticoduodenal region involvement

AIM：To characterize the factors of the improved survival following combined pancreaticoduodenectomy（PD） and gastrectomy for the treatment of advanced gastric cancer with pancreaticoduodenal region involvement.
METHODS：From 1995 to 2004,53 patients with primary gastric cancer were diagnosed with synchronous（n = 44） or metachronous（n = 9） pancreaticoduodenal region involvement.Of these,17 patients（32%） underwent total gastrectomy（TG） or distal subtotal gastrectomy（SG） combined with PD simultaneously.The preoperative demographic,clinical information,clinicopathologic features and the surgical results of these 17 patients were considered as factors influencing survival and were analyzed by the Kaplan-Meier method with log-rank comparison.
RESULTS：The actual 1-and 3-year survival rates of these 17 patients after resection were 77% and 34%,respectively,and three patients survived for more than 5 years after surgery.The tumor-free resection margin（P = 0.0174） and a well-differentiated histologic type（P = 0.0011） were significant prognostic factors on univariate analysis.No mortality occurred within one mo after operation,postoperative weight loss of different degree was present in all the patients with TG and 12 cases had other complications.There were 9（53%） cases of recurrence in 5-48 mo after operation.The survival rate in the palliative and explorative group was significantly（P = 0.0064） lower than in the combined PD group.
CONCLUSION： Judicious use of en bloc PD and gastrectomy and strictly preventing postoperative complications may improve the long-term survival for advanced gastric cancer patients with pancreaticoduodenal region involvement. Well-differentiated histology and negative resection margin are the most important predictors of long survival.     

Comparison between Resectable Helicobacter pylori-Negative and -Positive Gastric Cancers

Background/Aims

Controversy exists regarding the characteristics of Helicobacter pylori infection-negative gastric cancer (HPIN-GC). The aim of this study was to evaluate clinicopathologic features of HPIN-GC compared to H. pylori infection-positive gastric cancer (HPIP-GC) using a comprehensive analysis that included genetic and environmental factors.

Methods

H. pylori infection status of 705 resectable gastric cancer patients was determined by the rapid urease test, testing for anti-H. pylori antibodies, histologic analysis and culture of gastric cancer tissue samples, and history of H. pylori eradication. HPIN-GC was defined as gastric cancer that was negative for H. pylori infection based on all five methods and that had no evidence of atrophy in histology or serology.

Results

The prevalence of HPIN-GC was 4% (28/705). No significant differences with respect to age, sex, smoking, drinking, family history of gastric cancer or obesity were observed between the two groups. HPIN-GC tumors were marginally more likely to involve the cardia (14.3% for HPIN-GC vs 5.3% for HPIP-GC, p=0.068). The Lauren classification, histology, and TNM stage did not differ according to H. pylori infection status. Microsatellite instability was not different between the two groups, but p53 overexpression in HPIN-GC was marginally higher than in HPIP-GC (56.0% for HPIN-GC vs 37.0% for HPIP-GC, p=0.055).

Conclusions

The prevalence of HPIN-GC was extremely low, and its clinicopathologic characteristics were similar to HPIP-GC.     

Clinicopathologic factors and molecular markers related to lymph node metastasis in early gastric cancer

AIM: To analyze predictive factors for lymph node metastasis in early gastric cancer.METHODS: We analyzed 1104 patients with early gastric cancer(EGC) who underwent a gastrectomy with lymph-node dissection from May 2003 through July 2011. The clinicopathologic factors and molecular markers were assessed as predictors for lymph node metastasis. Molecular markers such as microsatellite instability, human mut L homolog 1, p53, epidermal growth factor receptor(EGFR) and human epidermal growth factor receptor 2(HER2) were included. The χ2 test and logistic regression analysis were used to determine clinicopathologic parameters.RESULTS: Lymph node metastasis was observed in 104(9.4%) of 1104 patients. Among 104 cases of lymph node positive patients, 24 patients(3.8%) were mucosal cancers and 80 patients(16.7%) were submucosal. According to histologic evaluation, the number of lymph node metastasis found was 4(1.7%) for well differentiated tubular adenocarcinoma, 45(11.3%) for moderately differentiated tubular adenocarcinoma, 36(14.8%) for poorly differentiated tubular adenocarcinoma, and 19(8.4%) for signet ring cell carcinoma. Of 690 EGC cases, 77 cases(11.2%) showed EGFR overexpression. HER2 overexpression was present in 110 cases(27.1%) of 406 EGC patients. With multivariate analysis, female gender(OR = 2.281, P = 0.009), presence of lymphovascular invasion(OR = 10.950, P 0.0001), diameter(≥ 20 mm, OR = 3.173, P = 0.01), and EGFR overexpression(OR = 2.185, P = 0.044) were independent risk factors for lymph node involvement.CONCLUSION: Female gender, tumor size, lymphovascular invasion and EGFR overexpression were predictive risk factors for lymph node metastasis in EGC.     

早期胃癌cyclin E表达的生物学意义

目的研究早期胃癌ｃｙｃｌｉｎＥ表达的生物学意义．方法用免疫组化法检测１０８例早期胃癌组织中ｃｙｃｌｉｎＥ和Ｐ５３的表达．结果正常胃腺体细胞几乎不染色,３３％（３６／１０８）的胃癌呈棕黄色．ＣｙｃｌｉｎＥ的总阳性率,在幽门部为４８％（２４／５０）,肉眼观混合型４６％（６／１３）,组织学分化型４０％（３１／７８）,Ｐ５３阳性者５４％（１９／３５）,均显著高于对照组．ＣｙｃｌｉｎＥ的强阳性率,在癌侵入粘膜下者是１８％（９／５１）,侵入静脉者２８％（５／１８）,侵入淋巴管者２８％（９／３２）,侵入淋巴结者３０％（４／１３）,都显著高于对照组．ＣｙｃｌｉｎＥ强阳性者五年生存率４０％（４／１０）,显著低下．结论ＣｙｃｌｉｎＥ阳性尤其是强阳性者恶性程度高     

Indications for pylorus-preserving gastrectomy for gastric cancer based on lymph node metastasis

BACKGROUND/AIMS: It is necessary to study the relation between lymph node metastasis in the suprapyloric or lesser curvature regions and clinicopathologic findings in order to determine the indications for pylorus-preserving gastrectomy. METHODOLOGY: We reviewed all pertinent data from the cases of 109 patients with gastric cancer located mainly in the middle third of the stomach focusing particularly on status of lymph node metastasis and clinicopathologic findings. All patients had been treated by conventional gastrectomy with regional lymph node dissection (D2 or D3). RESULTS: Lymph node metastases were found in the lesser curvature or suprapyloric regions in 18 patients. Primary tumors were located in the lesser curvature side in 15 of these 18 patients and in the greater curvature side in only 3. Primary tumors in the greater curvature side with involvement in the lesser curvature or suprapyloric lymph nodes were greater than 4.0 cm in diameter, whereas primary tumors in the lesser curvature side with such metastasis were greater than 1.3 cm. CONCLUSIONS: Indications for pylorus-preserving gastrectomy with preserving of the pyloric branch of the vagal nerve perhaps can be expanded to middle stomach cancer located in the greater curvature side that is less than 4.0 cm in diameter.     

Clinical profile of gastric cancer in Khuzestan, southwest of Iran

AIM: To analyze the characteristics of epidemiological, clinical and survival patterns among patients with carcinoma of the stomach. METHODS: We retrospectively studied the characteristics of 186 gastric adenocarcinoma patients at Ahwaz Jundishapur University Hospitals (AJSUH) from September 1, 1996 to September 1, 2002. All the patients had histopathologicallyconfirmed malignancy. Demographic variables, family history of gastric cancer (GC), clinicopathologic characteristics and treatment-related variables were analyzed. Univariate analysis was performed with the log-rank test and multivariate analysis with Cox regression. P ＜ 0.05 was considered statistically significant. RESULTS: Male to female ratio was 2.6:1. The meanage was 60.6 years and 14% of the patients were younger than 40 years. Adenocarcinoma, gastric lymphoma, and gastric metastasis were found in 94.5%,2.3%, and 3% patients, respectively. There was an average of 6-mo delay between the initial symptoms and the diagnosis. Among adenocarcinoma groups, intestinal type was the commonest (55.9%) and the distal third was the most common localization (88.4%). One hundred and thirty-four patients (72.1%) were males. Thirty-one patients (17%) had a family history of GC. Surgery was performed in 90% of patients (non-curative).CONCLUSION: The epidemiological features of GC in south Iran mimic those in high-risk areas. There is a higher frequency of GC in young patients at our institution. Patients are detected and treated after a relatively long delay. Most patients present in advanced stages, which favors a poor overall survival. Family history of GC has a significant problem in our area. Studying the etiology of this cancer in south Iran and earlier diagnosis and subsequent better cares are recommended.     

Clinical profile of gastric cancer in Khuzestan, southwest of Iran

AIM: To analyze the characteristics of epidemiological, clinical and survival patterns among patients with carcinoma of the stomach. METHODS: We retrospectively studied the characteristics of 186 gastric adenocarcinoma patients at Ahwaz Jundishapur University Hospitals (AJSUH) from September 1, 1996 to September 1, 2002. All the patients had histopathologicallyconfirmed malignancy. Demographic variables, family history of gastric cancer (GC), clinicopathologic characteristics and treatment-related variables were analyzed. Univariate analysis was performed with the log-rank test and multivariate analysis with Cox regression. P < 0.05 was considered statistically significant. RESULTS: Male to female ratio was 2.6:1. The mean age was 60.6 years and 14% of the patients were younger than 40 years. Adenocarcinoma, gastric lymphoma, and gastric metastasis were found in 94.5%, 2.3%, and 3% patients, respectively. There was an average of 6-mo delay between the initial symptoms and the diagnosis. Among adenocarcinoma groups, intestinal type was the commonest (55.9%) and the distal third was the most common localization (88.4%). One hundred and thirty-four patients (72.1%) were males. Thirty-one patients (17%) had a family history of GC. Surgery was performed in 90% of patients (non-curative). CONCLUSION: The epidemiological features of GC in south Iran mimic those in high-risk areas. There is a higher frequency of GC in young patients at our institution. Patients are detected and treated after a relatively long delay. Most patients present in advanced stages, which favors a poor overall survival. Family history of GC has a significant problem in our area. Studying the etiology of this cancer in south Iran and earlier diagnosis and subsequent better cares are recommended.     

Synchronous gastric tumors associated with esophageal cancer

Objective: Synchronous gastric tumors (including benign and secondary tumors) associated with esophageal cancer present diagnostic and therapeutic issues. We investigated this synchronous association, and retrospectively determined the frequency of the gastric tumors and the clinical characteristics.
Methods: In a series of 208 patients with esophageal cancer, we investigated the synchronous gastric tumors, as well as the frequency of association, clinicopathological characteristics, diagnosis, treatment, and the clinical outcome after surgery.
Results: Twenty-eight gastric tumors were found in 24 patients. Adenocarcinoma was most frequent. Most of these tumors were located at the upper or middle third of the stomach. Eight gastric tumors in six patients could not be detected preoperatively. Six of these tumors including a gastric remnant cancer were detected in the resected stomach, and two leiomyomas were detected during the operation. In one patient in which an endoscope could not pass through the esophagus, a leiomyoma was detected in the resected stomach. For the gastric cancers, total gastrectomy or proximal gastrectomy with lymph node dissections was performed. For the benign tumors, partial resection of the stomach was performed, and endoscopic resection was performed preoperatively for an adenoma. In both the postoperative hospital mortality rate and the survival rate after surgery, there were no significant differences between the patients with and without gastric tumors.
Conclusions: Synchronous gastric tumors associated with esophageal cancer are not rare. When an endoscope cannot pass through the esophagus before surgery, other techniques must be performed to explore the stomach. For these patients, surgical treatment should be adapted positively.     

Higher incidence of gastric remnant cancer after proximal than distal gastrectomy

BACKGROUND/AIMS: Proximal gastrectomy has been widely accepted as a standard operation for early stage gastric cancer located in the upper third of the stomach. Therefore, cancer of the distal gastric remnant is now increasing. The aims of this study were to clarify and compare the incidences of gastric remnant cancer after proximal and distal gastrectomy. METHODOLOGY: Data on a consecutive series of 809 cases of gastrectomy performed for early gastric cancer from 1991 to 2003 in Shikoku Cancer Center were analyzed retrospectively with respect to the incidence of gastric remnant cancer. RESULTS: We performed distal gastrectomy in 624 patients and proximal gastrectomy in 47 patients during the study period. After those operations, the gastric remnants of 457 cases and 33 cases, respectively, were surveyed periodically by endoscopic examination at our hospital. Among those surveyed cases, 10 patients (2.2%) and 3 patients (9.1%) were diagnosed as having gastric remnant cancer, respectively. The gastric remnant cancer-free survival after proximal gastrectomy was significantly lower than that after distal gastrectomy. CONCLUSIONS: Because of the higher incidence of gastric remnant cancer after proximal gastrectomy, it is more important to survey the gastric remnant after proximal gastrectomy periodically by postoperative endoscopic examination.     

Esophageal cancer after distal gastrectomy

The effect of gastrectomy on the subsequent development of esophageal cancer was investigated. Duodenogastroesophageal reflux is thought to be common in patients after distal gastrectomy, but whether this contributes to the development of esophageal cancer in such patients is controversial. We retrospectively evaluated 153 patients who underwent subtotal esophagectomy for thoracic esophageal cancer between January 2002 and July 2005. They were divided into two groups, according to whether or not they had previously undergone a gastrectomy: group 1, comprising 14 patients who had undergone gastrectomy and group 2, comprising 139 patients who had not. Clinical profiles of the patients were obtained from the medical records and the whole resected esophagus was histopathologically examined. The interval between gastrectomy and esophagectomy in group 1 was significantly shorter in the patients who had undergone gastrectomy for gastric cancer (10.5 +/- 4.2 years) than in those who had undergone gastrectomy for a peptic ulcer (28.9 +/- 3.0 years). The interval was also somehow shorter in the patients for whom anastomosis had been performed by Billroth I (21.3 +/- 5.6 years) compared with Billroth II (29.7 +/- 3.2 years), although the difference did not reach its statistical significance (P = 0.11). Moreover, the proportion of lower third tumors in patients after gastrectomy was significantly higher compared with that of the patients with intact stomach. These findings suggest that a history of gastrectomy is associated with more lower-third squamous cell esophageal carcinoma.