[Surgical treatment for carcinoma of gastric stump--a report on 13 patients].

Thirteen patients with carcinoma of gastric cardia after gastrectomy were treated in our hospital from 1981 to 1990. They comprised 1.3% of 932 cancers of the gastric cardia treated during the same interval. Partial esophagogastrectomy and esophagogastrectomy were performed under the aortic arch in 2 patients. Total gastrectomy was carried out in 8 patients with 7 Roux-Y and 1 end-to-side esophagojejunostomy. In the remaining 3 patients, only exploration was done. In the resected patients, two (20%) were complicated by anastomotic leak which was obviously higher than that by the conventional partial esophagogastrectomy for gastric cardia carcinoma. Due to reflux of bile and pancreatic juice, the incidence of gastric cardiac cancer in gastric stump after Billroth II operation was much higher than that following Billroth I type. Hence, Billroth I type should be the method of choice for patients to be operated by the distal partial gastrectomy. If Billroth I type was not feasible, Roux-Y anastomosis should be the alternative for Billroth II type in order to reduce the possibility of developing cancer in the proximal pouch. The route of entry, either left posterolateral thoracotomy or left thoracoabdominal incision should be resorted to in conformity with the size of the tumor.