Clinicopathological Study for Carcinoma of Remnant Stomach Reconstructed with Billroth I Method

Motoko Saito, Atsushi Nashimoto and Hiroshi Yabusaki

The Division of Surgery, Niigata Cancer Center Hospital

Background/Aims: We clinicopathologically evaluated carcinoma of the remnant stomach reconstructed by the Billroth I method. Patients and Methods: Subjects were patients with remnant gastric cancer after distal gastrectomy reconstructed by the Billroth I method and undergoing a second surgery at our hospital. The primary disease was benign in 20 (benign group) and malignant in 52 (malignant group).
Result: The average age at the second surgery was 60.5±12.1 years old in the benign group and 67.0±11.0 in the malignant group. Mean time between initial and remnant gastrectomy was 15.4 years in the benign group and 8.2 years in the malignant group. The male-to-female ratio was 17:3 in the benign group and 35:17 in the malignant group. In the benign group, 70% had remnant cancer in a nonanastomotic area, as did 80.8% in the malignant group. The benign group had 6 cases (30.0%) of early remnant cancer and the malignant group 24 cases (46.2%). Pathologically, well-differentiated adenocarcinomas were observed in 12 (60.0%) in the benign group and 35 (67.3%) in the malignant group. In the benign group, 70.0% showed lymph node metastasis, compared to only 28.8% in the malignant group. Nodal metastasis was high at No. 1, 3, and 7 in the benign group and at No. 2 and 11 in the malignant group. Six of 7 patients undergoing previous surgery for multiple gastric cancer had remnant stomachs resected within 6 years. The rate of advanced remnant cancer was 70.0% in the benign group and 53.8% in the malignant group. Conclusion: Why the interval between initial and subsequent resection was shorter in the malignant group was apparently because invisible multiple gastric cancer remained at the gastric remnant. It is therefore important to follow patients up annually by endoscopy after initial gastrectomy to detect the remnant gastric cancer at an early stage.

Key words
carcinoma of remnant stomach, reconstruction with Billroth I method, multiple gastric cancer, carcinoma after gastric ulcer surgery, carcinoma after gastric cancer surgery

Reprint requests
Motoko Saito The Division of Surgery, Niigata Cancer Center Hospital
2-15-3 Kawagishicyo, Niigata City, 951-8133 JAPAN

Accepted
September 24, 2003

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