Current Issues Regarding Remnant Gastric Cancer in Japan

Abstract

Remnant gastric cancer is a general term for gastric cancer which develops in the remnant stomach after a previous gastrectomy. Based on a large-scale survey conducted in Japan, we have elucidated current condition and strategies for remnant gastric cancer. Remnant gastric cancers can be roughly divided into three categories : “newly developed remnant gastric cancer after surgery for benign disease,” “metachronous multiple gastric cancer,” and “recurrence or relapse in the remnant stomach.” Currently, the most common remnant gastric cancers are metachronous multiple gastric cancers. The incidence of metachronous multiple gastric cancer is about 2% after distal gastrectomy and about 5% after proximal gastrectomy. Approximately one-thirds of metachronous multiple gastric cancers occur over five years after previous gastrectomy. Therefore, it is desirable to continue postoperative endoscopic follow-up studies as long as possible, though further incidence of remnant gastric cancer is gradually decreasing. Prognosis after resection of advanced remnant gastric cancer is slightly worse than that of common gastric cancer only in stage II patients. A total gastrectomy with lymph node dissection containing a splenic hilum is an appropriate procedure for them. Metachronous multiple gastric cancer after function-preserving gastrectomies such as segmental gastrectomy and local resection may become a problem in the future, but two-thirds of these can be resected by endoscopic submucosal dissection. Therefore, there is no need to avoid function-preserving surgery due to concerns related to metachronous multiple gastric cancer.