A clinicopathologic study on multiple gastric cancers with special reference to distal gastrectomy

Clinicopathological Predisposing Factors for Gastric Stump Cancer and Its Management: A Single-Center Analytical Study

Background The incidence of gastric stump carcinoma (GSC) is not declining because of the long latency period. The survival rate of treated gastric cancer patients has increased due to early detection and improvements in surgical techniques and chemotherapy. Increased survival rates and improved surveillance following gastric surgery have increased the incidence of GSC. Aim The study aims to investigate the clinicopathological factors affecting the interval between index gastric surgery and the occurrence of GSC, and our experience in the management of GSC is presented. Methods A retrospective review of patients diagnosed with GSC in our institution was completed. Patient characteristics and clinicopathological outcomes were analyzed. Results A total of 28 patients were included in this cohort with 17 (60.71%) males and 11 (39.28%) females. The mean interval from index surgery to the incidence of GSC was 24.42 years for benign etiology and six years for malignant etiology. Index surgeries were truncal vagotomy with 14 gastrojejunostomies (50%) and 14 subtotal gastrectomies (50%). The interval between index surgery and the incidence of GSC is not statistically significant concerning the type of surgery (p: 0.661), pathological TNM (tumor, nodes, metastases) stage (p: 0.520), pathological differentiation (p: 0.828), lymphovascular invasion (p: 0.252), perineural invasion (p: 0.672), and adjuvant therapy (p: -0.655). Survival was significantly higher in those patients who received curative resection in comparison to a palliative procedure (p: 0.041). Conclusion Strict surveillance for at least 10 years after initial gastric surgery is of utmost importance as half of the patients fated to develop GSC will do so within this time. In those patients with early diagnosis, no evidence of metastasis, and good performance status, curative surgery is feasible with acceptable morbidity.

Multiple early gastric carcinoma: Report of one case

Multiple early gastric carcinoma is a relatively rare clinical entity and is easy to be misdiagnosed for missing tumor lesions. Here we report such a case in a patient who was diagnosed with this rare disease by postoperative pathology after two surgeries. Major causes of misdiagnosis of this disease include the lack of experience with multiple early gastric carcinoma, limitations of medical examinations, and poor patient compliance. To increase the detection rate of multiple early gastric carcinoma, clinicians should increase knowledge about this disease to raise awareness. Chromoendoscopy and magnifying endoscopy should be used when conventional endoscopy is not enough to help establish a diagnosis. Careful intraoperative examination should also be guaranteed. Moreover, pathological examination of continuous sections of surgical specimens is necessary for a definite diagnosis.