An Advanced Gastric Cancer in the Remnant Stomach after Proximal Gastrectomy Not Detected for a Long-Term Period of Post-Operative Follow-up Due to Difficulty in Endoscopic Surveillance

Souya Nunobe, Shigekazu Ohyama, Masanori Tokunaga, Naoki Hiki, Tetsu Fukunaga, Yasuyuki Seto and Toshiharu Yamaguchi

Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital

We report a case of advanced gastric cancer in the remnant stomach after proximal gastrectomy, which was not detected over a long period of postoperative follow-up. A 79-year-old male had undergone proximal gastrectomy for early gastric cancer 11 years before. The annual examinations, including upper gastrointestinal endoscopy and abdominal ultrasonography, after the gastrectomy showed no recurrence of gastric cancer, but the remnant stomach had not been examined by endoscopy because of the long length of the interposed jejunum. The patient complained of vomiting two months before the present admission and was diagnosed as having advanced gastric cancer in the remnant stomach, with direct invasion of the transverse colon. Gastrectomy with combined resection of the pulled up jejunum and the transverse colon was undertaken, which turned out to be a non-curative resection with positive lavage cytology. In the present case, gastric cancer in the remnant stomach was not detected in its early stage due to the difficulty in observation of the remnant stomach. It is essential to devise an optimal reconstruction procedure after proximal gastrectomy and to conduct follow up of these patients for a long period of time after the initial surgery.

Key words
gastric cancer in the remnant stomach, proximal gastrectomy, surveillance after gastrectomy

Reprint requests
Souya Nunobe Department of Surgery, Metropolitan Komagome Hospital
3-18-22 Honkomagome, Bunkyo-ku, 113-8677 JAPAN

Accepted
November 19, 2008

To read the PDF file you will need Abobe Reader installed on your computer.