Role of re-resection in early gastric stump carcinoma

Between 1971 and 1990, 26 patients were diagnosed as having an early carcinoma in the gastric remnant after ulcer surgery. Three patients with proximal tumour location were operated on with total gastrectomy. The surgical strategy in the remaining patients with tumour adjacent to the anastomosis was re-resection of at least 5-6 cm of the anastomotic area and restoration of gastrointestinal continuity with a Roux-en-Y loop. A margin of at least 2 cm from the carcinoma to the resection line was taken. There was no postoperative mortality. In three cases the preoperative endoscopic and histological judgement of tumour classification and stage was incorrect; when the surgical specimens were examined one patient was found to have advanced carcinoma and in the other two no malignancy could be found. Median follow-up was 15 years (range 3-19 years). During follow-up, six of the re-resected patients developed recurrences, all located in the gastric remnant. Four patients with recurrence underwent reoperation with total gastrectomy, one had exploratory laparotomy and one had no further surgery. No postoperative deaths occurred. Three of the six patients died from gastric carcinoma. We conclude that this surgical strategy failed to prevent local recurrence of an early form of gastric carcinoma, considered to be potentially curable in virtually all cases. Partial resection of the gastric remnant as the treatment of choice in patients with early gastric stump carcinoma cannot be recommended.