Background: Gastric stump cancer may represent a malignancy with distinct clinical and pathological features due to the anatomical differences in lymphatic drainage determined by previous gastric resection. The presence of mesenteric lymph nodes metastases may not only difficult radical excision but also significantly affect survival of these patients. The purpose of this study was to determine the influence of anastomotic line invasion of the primary tumor and the risk of mesenteric lymph node metastases and survival.
Methods: seventy-two patients with gastric stump cancer managed by radical surgery were retrospectively reviewed. Resected specimens were reassessed to correlate the presence of anastomotic line (AL) tumor invasion with the presence of perigastric or mesenteric lymph node metastases and with survival.
Results: Overall, 54 patients had AL+ tumors. Of these, 66% had any lymph node metastases and 9% had mesenteric lymph node metastases. There was no correlation between the presence of AL+ and the risk of any or mesenteric lymph node metastases (p=0.5). Survival was significantly worse for patients with any lymph node metastases and for patients with mesenteric lymph node metastases (p<0.001 and p=0.003 respectively). Anastomotic line invasion had no significant impact on survival (p>0.05).
Conclusions: Anastomotic line tumor invasion is not a risk factor for mesenterial lymph node metastases and is not prognostic factor after radical surgery for gastric stump cancer. Lymph node metastases remains an independent and significant poor prognostic factor in gastric stump cancer