Gastric remnant recurrence--detection and implications for the management of gastric cancer

The ability of endoscopy to detect remnant recurrence of gastric cancer has been evaluated in patients, either as a follow-up procedure (17 patients) or after symptomatic referral (7 patients). Overall 15 out of 24 (62.5%) patients developed some form of recurrence. Fourteen out of 15 (94%) had local disease either alone or in combination with distant metastases. Remnant recurrence was observed in 11 of these and after excluding those referred with symptoms, the true incidence of remnant recurrence was 41.2%. Patients in the follow-up group had 'early' remnant lesions which were diagnosed sooner after surgery than in the symptomatic group who had 'advanced' remnant recurrences. The detection of premalignant histology occurred earlier in those who developed remnant recurrence and this short time interval could be used to predict recurrence. Despite the early diagnosis of remnant recurrence, resection of the remnant at second laparotomy was only possible in one patient as the majority had other sites of extensive recurrence. The implications for the management of 'early' and 'advanced' gastric cancer are discussed.