Related Experiment Video
Updated: Jul 8, 2026
Laparoscopic Radical Gastrectomy for Remnant Gastric Cancer
Published on: October 31, 2025
Gastric adenocarcinoma in the excluded stomach after Roux-en-Y gastric bypass: a case series, systematic review, and
Ikttesh Chahal1, Wade Hopper1, Audra King1
1Department of Surgery, School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, United States.
Background:
Primary remnant gastric cancer after Roux-en-Y gastric bypass presents a diagnostic challenge, and no consensus indications exist to guide the evaluation of the excluded anatomy when malignancy is suspected.
Methods:
We present a single-institution case series of 7 patients diagnosed with gastric adenocarcinoma of the excluded stomach after Roux-en-Y gastric bypass; all were diagnosed at an advanced stage within the last 3 years. A literature review was performed, and the combined findings were used to create a novel diagnostic algorithm.
Results:
A total of 55 patients with remnant gastric cancer were identified (7 institutional and 48 from the literature). The median time from gastric bypass to diagnosis was 15 years, and most patients had an advanced tumor stage. Before diagnosis, 24 patients (45%) had documented anemia, and 42 patients (78%) had abnormalities of the excluded stomach on cross-sectional imaging. The presence of either of these features may warrant remnant gastroscopy in appropriately selected patients.
Conclusion:
Anemia and radiographic evidence of excluded stomach abnormalities are both common among patients eventually diagnosed with remnant gastric cancer, and either of these findings should prompt consideration of accessing excluded anatomy.
