Development of Gastric Stump Carcinoma with Reference to the Reconstructive Procedure by N-methyl-N'-nitro-N-nitrosoguanidine in Rats

Yoshiro Horikawa

The First Department of Surgery, Kagoshima University School of Medicine

The development of gastric stump carcinoma following the administration of MNNG was studied in experimental animals. Special attention was paid to the reflux of duodenal contents into the remnant stomach, which was diversely caused by the type of reconstructive procedure. A total of 156 male Wistar rats were subjected to one of the following eight operative procedures: sham opeartion (SO, n=19), gastrotomy only (GT, n=10), gastrojejunostomy only (GJ, n=14), gastrectomy with Billroth I anastomosis (BI, n=24), gastrectomy with Billroth II anastomosis (BII, n=24), gastrectomy with Billroth II and Braun anastomosis (BII+Br, n=12), total duodenogastric reflux operation (R, n=33) and operation without duodenogastric reflux (NR, n=20). The animals were sacrificed 60 weeks after the operation, and their stomach or remnant stomach was removed and studied macroscopically, microscopically and electron microscopically. Atypical lesions were histologically divided into 3 grades: mild (Type I), moderate (Tvpe II) and severe (Type III). Combining Type III atypical lesion and carcinoma, the incidence was 30% in SO, 43% in GT, 88% in GJ, 29% in BI, 87% in BII, 38% in BII+Br, 89% in R and 42% in NR. The majority of these lesions occurred in the area of the gastroenteric anastomosis. Electron microscopically, destruction of the tight junctions in the intercellular junctional complex was observed in atypical and carcinomatous lesions. These results indicated that duodenogastric reflux was closely related to the development of atypical and carcinomatous lesions in the remnant stomach of rats and that destruction of tight junctions might participate in the mechanism of carcinogenesis in this situation.

Key words
N-methyl-N´-nitro-N-nitrosoguanidine, remnant stomach, duodenogastric reflux, carcinogenesis, tight junction

Reprint requests
Yoshiro Horikawa First Department of Surgery, Kagoshima University School of Medicine
8-35-1 Sakuragaoka, kagoshima City, 890 JAPAN

Accepted
December 9, 1992

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