Is there difference between anastomotic site and remnant stump carcinoma in gastric stump cancers? - a single institute analysis of 90 patients

Background: Little has been reported regarding differences between malignancies that develop at the anastomotic site (ASC) and those that develop at the remnant stump (RSC) in gastric stump carcinomas (GSC). The purpose of our study was to compare clinical, pathological and survival characteristics of ASC patients with those of RSC patients. Methods: Patients who underwent surgery for GSC between January 2005 and December 2017 were analyzed. Of the total 112 patients, 22 patients were excluded from the study due to extensive loss of data. Ninety patients underwent curative resection and were evaluated based on anatomic site at which they developed malignancy, i. e., ASC and RSC. Clinical, pathological and survival characteristics were assessed. Results: As per Lauren's classification, diffuse and intestinal variety were significantly associated with ASC (P=0.0001) and RSC (P=0.0001) respectively. RSC was associated with lower pT [pT2, 15/33 (45.5%), P=0.0002]. ASC was significantly associated with higher pN [pN3, 30/57 (52.6%), P=0.0013], stage [stage III, 48/57 (84.2%), P=0.0022], positive mesenteric nodes (P=0.006) and poor 3-year survival (10.5% versus 36.4%, P=0.003). Conclusions: ASC is substantially different than RSC. ASC is more aggressive disease compared to RSC and has different pathophysiology, higher rates of nodal involvement (both primary and mesenteric), presents with higher stage and has significantly poor 3-year survival.