Advertent problems about gastric stump cancer surgery / 中华胃肠外科杂志

ABSTRACT

Due to different disease background of gastric stump cancer(GSC) patients (benign or malignant lesion, reconstruction of digestive tract, etc.), the GSC surgical procedure and the difficulty of lymphadenectomy are also different. The extent of radical lymphadenectomy for gastric stump cancer should extend beyond D2 lymphadenectomy, according to the different backgrounds of initial disease, reconstructions, and tumor location. A lymphadenectomy should include the lymph nodes in anterior (No.17) and posterior (No.13) surface of the pancreatic head, along the superior mesenteric vein (No.14v), jejunal mesenteric lymph nodes, the splenic hilum (No.10), infra-diaphragm (No.19), esophageal hiatus of the diaphragm(No.20), para-esophageal nodes in the lower thorax (No.110) and supra-diaphragm (No.111). To achieve R0 resection, combined adjacent organ (transverse colon and spleen) resection is necessary in some cases. The indication for endoscopic submucosal dissection of early remnant gastric cancer is similar to primary early gastric cancer in selected patients. The advantages of laparoscopic and robot-assisted surgery for early remnant gastric cancer need to be confirmed through multicenter studies. Compared with primary proximal gastric cancer, remnant gastric cancer showed an equivalent survival rate. Roux-en-Y is the first choice for digestive tract reconstruction.