[Advertent problems about gastric stump cancer surgery]

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Gastric stump cancer (GSC) presents diverse challenges due to varied patient histories and surgical reconstructions.
• Standard lymphadenectomy protocols may be insufficient for GSC, necessitating tailored approaches.

Purpose of the Study:

• To define an extended lymphadenectomy strategy for gastric stump cancer (GSC).
• To outline surgical considerations and reconstruction options for GSC.
• To compare survival outcomes of GSC with primary gastric cancer.

Main Methods:

• Review of surgical procedures and lymphadenectomy extent for GSC.
• Identification of key lymph node stations for extended dissection (e.g., No. 10, 13, 14v, 17, 19, 20, 110, 111).
• Discussion of indications for adjacent organ resection and endoscopic submucosal dissection.

Main Results:

• Extended lymphadenectomy beyond D2 is recommended for GSC, encompassing specific pancreatic, mesenteric, splenic, and diaphragmatic nodal regions.
• Resection of adjacent organs like the spleen or transverse colon may be required for R0 resection.
• Endoscopic submucosal dissection is viable for selected early GSC cases.
• Laparoscopic and robot-assisted surgery benefits require further validation.
• Remnant gastric cancer survival rates are equivalent to primary proximal gastric cancer.

Conclusions:

• An individualized, extended lymphadenectomy is crucial for effective GSC management.
• Roux-en-Y reconstruction is the preferred method for digestive tract reconstruction after GSC surgery.
• Further multicenter studies are needed to confirm the benefits of minimally invasive techniques in GSC treatment.