[Cancer of the gastric stump. Apropos of 14 recent cases]

14 primary cancers of the gastric stump developing after low partial gastrectomy for a benign ulcerative gastroduodenal lesion have been treated in 7 years (1976-1982). The necessarily cautious criterion of definition is a postoperative interval of over 15 years. Indeed, it seems very unlikely that a gastric cancer could remain unrecognised and asymptomatic throughout this period. This personal series, together with a review of the recent literature (352 cases), makes it possible to clarify various facts concerning this non-fortuitous anatomic and clinical entity. The clinical aspect is quite characteristic, marked after a silent latent interval (average postoperative delay 27 years) by epigastric pain, vomiting, dysphagia and eventual change in general condition. The frequency is increasing, even though gastric cancer is on the decline whatever the geographic zone considered (in France from 1952 to 1968 the incidence per 100,000 inhabitants fell from 27.2 to 19 per cent). The average frequency of cancer of the gastric stump is estimated as 2.5 per cent of the totality of cancers of the stomach. The risk of developing a cancer of the gastric stump varies around 3 per cent in those undergoing gastrectomy for an ulcer. Moreover, this risk increases with the passage of time. The marked preponderance of the male sex remains unexplained. The initial site of the ulcer is so often unknown as to permit no definitive conclusion. It must therefore be considered that cancer of the gastric stump is really the direct consequence of the surgical procedure of excision.(ABSTRACT TRUNCATED AT 250 WORDS)