Evidence to support a unified pathogenesis of gastric stump cancer

Background Many studies indicate that remote partial gastrectomy for benign disease should be considered a premalignant condition. The reported overall risk of gastric stump cancer is approximately a 2-fold increase, but patients more than 20 to 25 years postoperatively may have a 4- to 5-fold increased risk, compared to the age- and sex-matched general population. Methods In a review the risks, the pathogenesis and the value of endoscopy to avoid gastric stump cancer are described. Results The duration of postoperative interval seems the most important risk factor. The first 10 years after initial surgery. gastric cancer risk may be reduced due to the removal of the most cancer prone distal part of the stomach, but thereafter there seems a rapid increase of the relative risk. The etiology and precise mechanism of carcinogenesis is unknown but the time relationship with the surgery suggests that alterations induced by the operation must be important. Premalignant and precursor lesions apparently occur more frequently in the gastric remnant after peptic ulcer surgery and endoscopic bioptic screening can detect early stump cancers at a curable stage. Conclusions Large scale screening programs of post-gastrectomy patients are nevertheless not recommended; the yield of early stomach carcinomas appears too low to justify surveillance. The individual postgastrectomy patient willing to undergo regular endoscopy may however benefit from such approach. In that event, multiple biopsies should be taken to assess the microscopic appearance of the mucosa. Especially dysplasia is considered as a dependable morphologic marker for the neoplastic potential of the gastric remnant and requires close follow-up.