[Carcinoma of the gastric stump. Diagnosis, surgical procedure and prognosis].

The results of a retrospective analysis of cases of gastric stump cancer are reported. Among 298 gastric carcinomas treated between 1. 1. 1986 and 1. 3. 1994, we found 28 (9.5%) cases of gastric stump cancer. Gastric carcinoma showed a male preponderance, with a male:female ratio of ca. 4:1. Two thirds of the patients were older than 70 years at the time of diagnosis. In 27 of 28 patients the original operation performed was a Billroth II resection without Braun's enteroanastomosis. The mean time lag before the development of gastric stump cancer was significantly shorter in the group of patients older than 45 years at the time of first operation (n = 16) than in patients 45 years or younger (n = 12, P = 0.03). Endoscopy with biopsy and endosonography were highly reliable diagnostic instruments. The capability of CT for recognizing lymphatic metastasis is poor (42.1% sensitivity). The main risk factors for the development of gastric stump cancer, according to our data, are male sex, Billroth II resection for first reconstruction, age over 45 years at first operation, and gastric ulcer as reason for the original gastric resection. The cost benefit ratio and timing of endoscopic screening of partially gastrectomized patients are discussed.