A Case of Secondary Early Gastric Carcinoma Developing in a Residual Stomach 3 Years After Laparoscopic Wedge Resection for Early Gastric Cancer

Abstract

A 64-year-old Japanese man visited Yokohama Seamen's Insurance Hospital in October 1994, for careful examination of his stomach, because the gastrogram at medical check up one month before had indicated the slight transformation of the antrum. An early gastric carcinoma type IIc＋IIa, 15 mm in diameter, at the greater curvature of the antrum was diagnosed by gastrogram and endoscopy. On November 21, 1994, laparoscopic wedge resection of the stomach using a lesion-lifting method was performed. Macroscopically the lesion was resected at least 10 mm from the margin. Histopathological examination showed moderately differentiated adenocarcinoma within the mucosal layer. He was discharged on December 9, 1994, to follow in an outpatient basis.
His residual stomach was examined every 4 months by endoscopy. No abnormal findings had been found until December 1996. However, on April 1997, endoscopy and gastrogram indicated type IIc early gastric cancer, 20 mm in diameter, at the posterior wall of the middle of the residual stomach. On May 20, 1997, distal gastrectomy was performed. Macroscopically, the distance between secondary carcinoma and the scar of the surgery in 1994 was 20 mm. Histopathological examination showed well differentiated adenocarcinoma within the mucosal layer. He was discharged uneventfully on July 6, 1997.