Entirely Laparoscopic Gastrectomy and Colectomy for Remnant Gastric Cancer with Gastric Outlet Obstruction and Transverse Colon Invasion

It is well known that gastrectomy with curative intent is the best way to improve outcomes of patients with remnant gastric cancer. Recently,several investigators reported their experiences with laparoscopic gastrectomy of remnant gastric cancer. We report the case of an 83-year-old female patient who was diagnosed with remnant gastric cancer with obstruction. She underwent an entirely laparoscopic distal gastrectomy with colectomy because of direct invasion of the transverse colon. The operation time was 200 minutes. There were no postoperative complications. The pathologic stage was T4b (transverse colon) N0M0. Our experience suggests that laparoscopic surgerycould be an effective method to improve the surgical outcomes of remnant gastric cancer patients.

Postoperative Follow-up of Early Gastric Cancer

Since early gastric cancer (EGC) patients show an excellent surgical outcome and a long-term survival rate, the purpose and methods of postoperative follow-up need to be reconsidered. The recurrence rate after surgery is less than 2% in EGC. The mode of recurrence is diverse, of which hematogeous metastasis being most frequently encountered. Post-gastrectomy patients have a risk of nutritional deficiency and more chances to develop remnant gastric tumor or secondary tumor than normal population. Based on the pattern and developmental time span of recurrence, postoperative follow-up program for EGC should not be different from that for advanced gastric cancer. Most Korean doctors' post-operative follow-up with the patients range up to 5 years with an interval of 4 to 6 months. Gastroscopy, CT, and tumor markers are used for follow-up by more than 50% of doctors. Due to the increased rate of long-term survival, follow-up program should include assessment of functional aspect and nutritional well-being of the patients. Epidemiological studies for the long-term survivors and specialized strategies need to be developed for management of postgastrectomy cancer patients. Although early detection of recurrence is the primary goal of post-operative follow-up, postgastrectomy patients should be recognized as a risk group in terms of nutritional and medical problems on a life-long basis, and long-term management strategy should be developed.

Clinicopathologic Study of Remnant Gastric Cancer

PURPOSE: Remnant gastric cancer (RGC) is usually diagnosed at an advanced stage, and consequently the prognosis is poor. This retrospective study was performed to evaluate the clinicopathological characteristics and prognosis of RGC. METHODS: A total of 39 patients, with RGC, were diagnosed after a partial gastrectomy, at the Dept. of Surgery, Korea University College of Medicine between September 1983 and December 2000 (7 for benign gastric diseases, the B group and 32 for gastric carcinoma, the M group). The clinicopathological features and 5-year survival rates were investigated for the two groups. RESULTS: The average age was 54.1+/-10.1, and a male predominance was shown. The latency period between the initial surgeries were 35.3+/-25.3 and 142.0+/-71.9 months for groups M and B, respectively. 21 (66%) of the tumors were located in the anastomosis site in the M group, with 4 (57.1%) in the non-anastomosis site in the B group. Significant differences were seen in the latency period and tumor location between the two groups. According to the operation method, RGC mainly developed in the non-anastomosis site in patients having undergone the Billroth I method, whereas it developed in the anastomosis site in cases having undergone the Billroth II method (P=0.047). The overall 5 year survival rate was 42.8%, 71.4% in the B group and 37.2% in the M group. CONCLUSION: There were differences in the latency periods and locations between the benign and malignant groups, and the prognosis with the remnant gastric cancer was no different from that of primary gastric cancer. These results suggest that the early detection of gastric cancer in the remnant stomach, by periodical follow up, is important.

Clinical Analysis of Operative treatment of Remnant Gastric Cancer / 대한암학회지

PURPOSE: Authors analyzed the clinico-pathologic parameters of 34 remnant gastric cancers to know the general behavior and prognosis of remnant gastric cancer. MATERIALS AND METHODS: Medical records of 34 patients were reviewed retrospectively, who were diagnosed as remnant gastric adenocarcinoma and underwent operation in Korea Cancer Center Hospital from February of 1988 to March of 1998. RESULTS: The incidence of remnant gastric cancer was 0.7% (34/4,904 cases). Sex ratio, male to female, was 2.8: 1. Mean age was 55 years of age. Diagnoses of primary lesion were 10 cases of benign lesion, 24 cases of malignant lesion. The operation for the remnant gastric cancer is total gastrectomy or extended total gastrectomy. The most common extended-resected organ was spleen (21 cases). The morbidity following operation of remnant gastric cancer were quite rare and treated conservatively. The overall five year survival rate was 11.3%. CONCLUSION: Authors concluded that aggressive operation of remnant gastric cancer is warranted, as it is proved relatively safe and is the only option to lengthen patients survival and to alleviate their QOL (quality of life).

Remnant Gastric Cancer

Remnant gastric cancer is defined broadly as cancer that develops in the remnant stomach after the resection of nonmalignant or malignant lesions. Generally speaking, remnant gastric cancer is defined as its interval between previous gastrectomy and the detection of remnant gastric cancer must be over 10 years in the previous malignant or nonmalignant lesions. From Aug. 1988 to Dec. 1995, fifteen patients who were operated as remnant gastric cancer (broad definition) in Hanyang Universty Hospital was reviewed as follows. Sex distribution was 12 cases in male and 3 cases in female. Peak incidence of age was 5th and 6th decades.The T.N.M. staging was at first operation: benign disease in 6 cases, stage I in 4 cases, stage IIIa in 1 case, stage IIIb in 2 cases and unknown stage in 2 cases, and at 2nd operation; stage I in 3 cases,stage II in 1 case, stage IIIa in 2 cases, stage IIIb in 5 cases, stage IV in 4 cases. The interval between first and second operation was as follows : less than 5 years in 4 cases, 5 to 10 years in 2 cases, 10 to 15 years in 3 cases, and over 20 years in 6 cases. The procedure at first operation was Billroth II procedure, and the procedure at 2nd operation was as follows: total gastrectomy with Roux-en-Y esophagojejunostomy in 12 cases,total gastrectomy with loop esophagojejunostomy in 2 cases,dismentling partial gastrectomy with Roux-en-Y gastrojejunostomy in 1 case. In our opinion,early diagnosis of remnant carcinoma following gastric surgery by the endoscopic follow up and aggresive surgery are important to improve disease free interval and patient survival.