Gastric stump carcinoma--new aspects deduced from experimental results

The actual influence of surgical technique on the pathogenesis of gastric stump carcinoma has not been fully explained, even under experimental conditions. We attempted to elucidate the problem by a series of experiments with Wistar rats assessing the postoperative consequences of Billroth I resection, B II resection with Roux-en-Y gastroenterostomy, B II resection with Braun's anastomosis, and plain gastroenterostomy without resection, and defining their influence on the development of carcinoma in the gastric remnant. Based on general clinical observations and randomized endoscopic and radiologic examinations, the date for killing and autopsy was fixed on the 56th after the surgical intervention. The number of malignant neoplasms was found to rise in proportion with the intensity of duodenogastric reflux resulting from the respective operative procedures: No tumors were found after B II resection with Roux-en-Y gastroenterostomy, but tumor incidence in the other groups rose from 10% in the animals subjected to B I resection, to 23.1% in those with B II resection plus Braun's anastomosis, and finally to 30% in animals with B II resection only, but no Braun's anastomosis. Gastroenterostomy without any resection even produced a tumors incidence of 70.8%. The present paper is presumably the first to report about gastric carcinomas that arose after surgery alone, without additional carcinogen exposure.