Treatment of residual gastritis and residual gastric cancer

What is gastric remnant cancer? Gastric remnant cancer generally refers to residual gastric malignant tumors that occur after surgery for benign gastric diseases. If the surgery is performed for malignant lesions, it should refer to gastric cancer that occurs more than 20 years after the surgery. Gastric remnant cancer can occur in the remaining stomach after subtotal gastrectomy, or in the entire stomach after simple gastrointestinal anastomosis, simple perforation repair, or vagus nerve transection.

Causes of gastric stump cancer

The cause of gastric stump cancer is not yet fully understood. It may be because gastric surgery changes the normal anatomy and physiological function of the stomach, exposing the stomach to more carcinogens and cancer promoters. It is generally believed that the occurrence of gastric stump cancer is closely related to the following factors:

1. Gastric mucosal damage: This is mainly because, on the one hand, after a subtotal gastrectomy or vagus nerve severance, the stomach is in a low-acid or acid-free state, and the decreased secretion of gastrin reduces the protective mucus of the gastric mucosa, leading to the gradual atrophy of the gastric mucosa; on the other hand, the reflux of bile, pancreatic juice and intestinal juice after gastric surgery causes greater damage to the gastric mucosa. Damage to the gastric mucosa can lead to chronic atrophic gastritis, intestinal metaplasia and atypical hyperplasia, which is the main cause of residual gastric cancer after gastric surgery.

2. Reduced gastric acid: Gastric acid decreases after gastric surgery, causing bacteria to grow and multiply extensively in the stomach. Bacterial toxins and bile metabolites decomposed by bacteria have a carcinogenic effect. In addition, bacteria containing nitrate reductase can promote the synthesis of nitrosamines (carcinogens). These carcinogenic and cancer-promoting substances may cause gastric mucosal cancer.

3. Scars: According to relevant information, scars after gastric surgery (even the irritation of non-absorbable sutures) may also lead to the occurrence of residual gastric cancer.

4. Surgical method: The type of gastric surgery is not an important factor, but most reports show that patients who underwent Bifocal II and simple gastrojejunostomy after subtotal gastrectomy are more likely to develop residual gastric cancer than those who underwent Bifocal I, which may be due to the fact that Bifocal II surgery is more commonly used. In addition, there are reports that patients who underwent vagotomy and drainage for the treatment of duodenal ulcers developed gastric cancer within 5 years after surgery.

Clinical manifestations and diagnosis of gastric stump cancer

The clinical manifestations of gastric remnant cancer are roughly the same as those of general gastric cancer. Symptoms such as sudden loss of appetite, weight loss, occult blood in stool, and persistent pain in the upper abdomen that cannot be relieved by antacids and antispasmodics more than 10 years after gastrectomy are specific manifestations of this disease. The main method of diagnosis is gastroscopy and biopsy of the mucosa in suspicious areas, with an accuracy rate of more than 90%. In addition, X-ray barium meal angiography often misses smaller lesions because gastric surgery changes the normal anatomy and physiological function of the stomach, and its diagnosis rate is only about 50%.