Prognostic analysis of remnant gastric cancers with metastatic lymph nodes

Abstract

Purpose: The lymphatic distribution of remnant gastric cancer differs depending on the procedure of primary gastrectomy. We retrospectively evaluated the clinicopathological characteristics and the outcomes in node positive remnant gastric cancer patients, and analyzed the localization and rate of lymph node metastases by the difference in primary procedure. Methods: Forty-nine patients with remnant gastric cancer who underwent completion gastrectomy in our hospital between January 2001 to August 2012 were analyzed retrospectively. Results: The nodepositive group was 12 cases, and the node-negative group was 37 cases. The rate of depth of invasion, lymphatic and venous invasion and the undifferentiated type carcinoma in the node positive group were high comparing with the node negative group. Nine patients (75%) in the node positive group had recurrence, and the median time for relapse-free interval was 8.5 months (range, 2-30 months). The cumulative 5-year survival proportion was significantly different between the node positive group (0%) and the node negative group (82%) (P < 0.001). In the gastrojejunostomy primary procedure group (Billroth II reconstruction or Roux-en-Y reconstruction), the tendency of metastases to be located at the mesojejunal lymph node station was observed. Conclusion: The node-positive remnant gastric cancer patients showed poor prognosis. To improve the outcome, dissection of the mesojejunum should be meticulously performed in the gastrojejunostomy group, and intensive adjuvant chemotherapy is required to prevent recurrence.