J Korean Gastric Cancer Assoc.  2001 Sep;1(3):144-149.

Gastric Stump Cancer

Affiliations
  • 1Department of Surgery, College of Medicine, Kosin University, Busan, Korea. khchoi@ns.kosinmed.or.kr
  • 2Bioanalysis and Biotransformation Research Center, Korea Institute of Science and Technology, Seoul, Korea.

Abstract

PURPOSE: Gastric stump cancer is defined as a cancer that develops in the stomach after a resection in cases of non-malignant or malignant gastric disease. The interval between the gastrectomy and the detection of gastric stump cancer must be over 5 years. Since duodenogastric reflux gastritis is a precancerous condition and one of the most important factors inducing gastric stump cancer, we compared the bile-acid content of gastric juice between gastric stump cancer patients and controls. MATENRIALS AND METHODS: To evaluate retrospectively the surgical treatment of patients with gastric stump cancer, we reviewed the cases histories of 1016 stomach cancer patients who had been operated on at the Department of General Surgery, Kosin University Gospel Hospital, between 1995 and 1998. The gastric juice was collected during the operations on the gastric stump cancer patients by using a needle puncture of the fundus of the stomach and during the endoscopic examinations of the control subjects. The samples were analyzed for various bile acids (gas chromatography/mass spectrometry).
RESULTS
The 6 gastric stump cancer cases accounted for 0.6% of all gastric cancer patients; 5 patients were first operated on for a peptic ulcer and the remaining one for an adenocarcinoma of the stomach. All of the cases were men. The reconstruction method after the initial gastrectomy was a Billroth II in all cases. The sites of the gastric stump cancer were the anastomotic sitein 2 patients, the upper body in 2, the fundus in 1 and the cardia in 1. The operative methods were 3 total gastrectomies, 2 subtotal gastrectomies with Roux en Y anastomosis, and 1 partial gastrectomy with lymph node dissection and had a curative intention in all patients. All of the patients were still surviving at the time of this report. The gastric juices of 4 gastric stump patients showed significantly higher contents of cholic acid (36.42microgram/ ml) compared to the gastric juices of 35 control subjects (12.82microgram/ml)(p< or =0.0001). Chenodeoxycholic acid and lithocholic acid were not significantly different.
CONCLUSION
The gastric juice of gastric stump cancer patients contained a significantly higher cholic acid content. At the time of the initial gastrectomy, an operative method that prevents duodenogastric reflux may prevent or minimize the development of gastric stump cancer, and more aggressive surgical treatment may improve survival.

Keyword

Gastric stump cancer; Bile acid; Duodenogastric reflux

MeSH Terms

Adenocarcinoma
Anastomosis, Roux-en-Y
Bile Acids and Salts
Cardia
Chenodeoxycholic Acid
Cholic Acid
Duodenogastric Reflux
Gastrectomy
Gastric Juice
Gastric Stump*
Gastritis
Gastroenterostomy
Humans
Intention
Lithocholic Acid
Lymph Node Excision
Male
Needles
Peptic Ulcer
Precancerous Conditions
Punctures
Retrospective Studies
Stomach
Stomach Diseases
Stomach Neoplasms
Bile Acids and Salts
Chenodeoxycholic Acid
Cholic Acid
Lithocholic Acid
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