Clinicopathological characteristics and survival difference between gastric stump carcinoma and primary upper third gastric cancer.

Background: The increased incidence of early gastric cancer in several Asian countries has been associated with an increase in gastric stump carcinoma (GSC) following gastric cancer surgery. The clinicopathological characteristics of GSC remain unclear because of the limited number of patients with GSC.

Methods: The clinicopathological characteristics, including the 5-year survival rate of patients with GSC following distal gastrectomy (167 patients), were compared with those of patients with primary upper third gastric cancer (PGC; 755 patients). The clinicopathological characteristics of patients with GSC were also compared between those who had initial surgery for gastric cancer (GSC-M group, 78 patients) and for benign lesions (GSC-B group, 89 patients).

Results: The GSC-B group has a greater male/female ratio (13.8 vs. 3.1) and a longer interval between initial gastrectomy and surgery for GSC (31.0 vs. 9.4 years) than the GSC-M group. The 5-year survival rate was not significantly different between the GSC-B group (49.0 %) and the GSC-M group (59.3 %, P = 0.359). A comparison between the GSC group and the PGC group revealed a poorer 5-year survival rate for the GSC group (53.6 %) than the PGC group (78.3 %, P < 0.001), and the same trend was observed even after stratification by the pathological stage.

Conclusions: Stump carcinoma arises earlier following gastrectomy for malignant disease than for benign disease. The prognosis was poor in patients with GSC compared to those with PGC. Early detection of GSC is necessary and an appropriate follow-up program should be established.