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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2016; 22(8): 2424-2433
Published online Feb 28, 2016. doi: 10.3748/wjg.v22.i8.2424
Current status in remnant gastric cancer after distal gastrectomy
Masaichi Ohira, Takahiro Toyokawa, Katsunobu Sakurai, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Masakazu Yashiro, Naoyoshi Onoda, Kosei Hirakawa
Masaichi Ohira, Takahiro Toyokawa, Katsunobu Sakurai, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Masakazu Yashiro, Naoyoshi Onoda, Kosei Hirakawa, Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
Author contributions: Ohira M and Toyokawa T contributed equally to prepare this manuscript; Ohira M and Toyokawa T wrote the manuscript; Ohira M, Toyokawa T and Onoda N designed the review; Sakurai K, Kubo N and Tanaka H collected the references and analyzed data; Ohira M, Toyokawa T and Muguruma K contributed drafting of manuscript; Onoda N and Hirakawa K revised the manuscript critically; all authors read and approved the final manuscript.
Conflict-of-interest statement: All authors have no conflicts of interest or financial ties to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Naoyoshi Onoda, MD, PhD, Associate Professor, Department of Surgical Oncology, Osaka City University Graduate School of Medicine 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan. nonoda@med.osaka-cu.ac.jp
Telephone: +81-6-66453838 Fax: +81-6-66466450
Received: April 28, 2015
Peer-review started: May 6, 2015
First decision: August 25, 2015
Revised: November 9, 2015
Accepted: December 12, 2015
Article in press: December 14, 2015
Published online: February 28, 2016
Processing time: 302 Days and 23.8 Hours
Abstract

Remnant gastric cancer (RGC) and gastric stump cancer after distal gastrectomy (DG) are recognized as the same clinical entity. In this review, the current knowledges as well as the non-settled issues of RGC are presented. Duodenogastric reflux and denervation of the gastric mucosa are considered as the two main factors responsible for the development of RGC after benign disease. On the other hand, some precancerous circumstances which already have existed at the time of initial surgery, such as atrophic gastritis and intestinal metaplasia, are the main factors associated with RGC after gastric cancer. Although eradication of Helicobacter pylori (H. pylori) in remnant stomach is promising, it is still uncertain whether it can reduce the risk of carcinogenesis. Periodic endoscopic surveillance after DG was reported useful in detecting RGC at an early stage, which offers a chance to undergo minimally invasive endoscopic treatment or laparoscopic surgery and leads to an improved prognosis in RGC patients. Future challenges may be expected to elucidate the benefit of eradication of H. pylori in the remnant stomach if it could reduce the risk for RGC, to build an optimal endoscopic surveillance strategy after DG by stratifying the risk for development of RGC, and to develop a specific staging system for RGC for the standardization of the treatment by prospecting the prognosis.

Keywords: Remnant gastric cancer; Helicobacter pylori; Endoscopic treatment; Surveillance; Laparoscopic surgery

Core tip: There seemed two different categories of remnant gastric cancer. One develops at the stomal area following distal gastrectomy for benign disease after a long latency period, caused by the duodenogastric reflux. The other develops in the remnant stomach following gastric cancer surgery during the follow-up period, correlated with Helicobacter pylori. Early detection and aggressive surgical approach are essential to improve the prognosis. A specific staging system should be necessary to predict the prognosis. Minimally invasive treatments, such as endoscopic or laparoscopic surgery, have been applied recently.