A Study of the Remnant Stomach from the Aspect of Primary Lesion

Hideaki Nishidoi, Minoru Ishiguro, Hirofumi Kudoh, Nobuaki Kaibara*

Department of Surgery, Tottori Red Cross Hospital
*First Department of Surgery, Tottori University School of Medicine

The mechanism of development of cancer in the remnant stomach was studied by comparing 33 patients originally operated on for benign tumors (benign group) with 11 patients originally operated on for malignant tumors (malignant group). In the benign group, the B-II operative procedure was predominant, while B-I and B-II were conducted on an almost equal number of patients in the malignant group. Cancer developed at the anastomosed site or the cut end in significantly more cases in the benign group than in the malignant group. Many tumors in the malignant group exhibited gross morphology similar to that of the original gastric cancer. The intervals between onset of the first and second tumor by the site of the second tumor in the benign group were 23.2, 20.1 and 10.9 years at the anastomosed site, the cut end, and other sites, respectively. In the malignant group, the intervals were 14.3, 11.8 and 12.4 years. The malignant group showed no difference among the sites, though the intervals were shorter than in the benign group. These results indicate that the reflux of duodenal juice including bile at the anastomosed site of the remnant stomach may be the promoter in the benign group. However, in the malignant group the results in terms of the site and the intervals of tumor development indicate that the high risk of development of multiple cancers of the stomach rather than the promoting effect of bile acid may play a greater role in recurrence of the tumor.

Key words
cancer of gastric remnant, carcinogenesis, duodenogastric reflux, metachronous multiple cance

Reprint requests
Hideaki Nishidoi Department of Surgery, Tottori Red Cross Hospital
117 Shoutokuchou, Tottori, 680 JAPAN

Accepted
September 9, 1992

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