Gastric carcinoma after surgical treatment for benign ulcer disease: some pathologic-anatomic aspects

The study presents the autopsy findings on 55 patients with carcinoma of the operated stomach. This figure corresponds to a proportion of about 0.12% of the total number of autopsies (46,593) in the period under review (1950-1982), and of about 7.24% of the overall number of gastric carcinoma patients autopsied during that period. The male:female ratio was 5.1:1. The average "free interval" until the manifestation of cancer was 22.6 years after Billroth II resection, 23.4 years after Billroth I resection, and 34.4 years in the case of patients upon whom gastroenteroanastomosis had been performed without resection. The older the patient was at the time of the operation, the shorter was the interval before the occurrence of gastric cancer. In the majority of cases the carcinoma was localized in the gastric stump (65.4%), whereas in a quarter of the cases (25.5%) the carcinoma occurred in the area of the anastomosis itself, and in 9.1% of cases it was localized in the region of the cardia. Histologic classification of the tumors revealed 52.7% as being predominantly of the intestinal type, and 38.2% as being predominantly of the diffuse type. The organs most frequently affected by direct tumor infiltration "per continuitatem" were the pancreas (18.2%), liver (16.4%) and colon transversum (14.6%). The lymph nodes most often affected were the paragastric (63.6%) and parapancreatic lymph nodes (49.1%), those at the porta hepatic (38.2%) and the para-aortal (34.6%) lymph nodes. Haematogenous metastases were found most frequently in the liver (30.9%), skeletal system (16.4%), adrenal gland (10.9%) and lung (9.1%).(ABSTRACT TRUNCATED AT 250 WORDS)