Gastric cancer following pancreaticoduodenectomy: Experience from a high-volume center and review of existing literature

Michael Johannes Pflüger, MD; Matthäus Felsenstein, MD; Ryan Schmocker, MD; Laura DeLong Wood, MD, PhD; Ralph Hruban, MD; Kohei Fujikura, MD, PhD; Noah Rozich, MD; Floortje van Oosten, MD; Matthew Weiss, MD; William Burns, MD; Jun Yu, MD, PhD; John Cameron, MD; Johann Pratschke, MD; Christopher Lee Wolfgang, MD, PhD; Jin He, MD, PhD; Richard Andrew Burkhart, MD

Surgery Open Science (Oct 2020)

Gastric cancer following pancreaticoduodenectomy: Experience from a high-volume center and review of existing literature

Michael Johannes Pflüger, MD,
Matthäus Felsenstein, MD,
Ryan Schmocker, MD,
Laura DeLong Wood, MD, PhD,
Ralph Hruban, MD,
Kohei Fujikura, MD, PhD,
Noah Rozich, MD,
Floortje van Oosten, MD,
Matthew Weiss, MD,
William Burns, MD,
Jun Yu, MD, PhD,
John Cameron, MD,
Johann Pratschke, MD,
Christopher Lee Wolfgang, MD, PhD,
Jin He, MD, PhD,
Richard Andrew Burkhart, MD

Affiliations

Michael Johannes Pflüger, MD: Johns Hopkins School of Medicine, Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Baltimore, MD, USA; Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Surgery (CCM/CVK), Berlin, Germany
Matthäus Felsenstein, MD: Johns Hopkins School of Medicine, Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Baltimore, MD, USA; Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Surgery (CCM/CVK), Berlin, Germany
Ryan Schmocker, MD: Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
Laura DeLong Wood, MD, PhD: Johns Hopkins School of Medicine, Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Baltimore, MD, USA
Ralph Hruban, MD: Johns Hopkins School of Medicine, Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Baltimore, MD, USA
Kohei Fujikura, MD, PhD: Johns Hopkins School of Medicine, Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Baltimore, MD, USA
Noah Rozich, MD: Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
Floortje van Oosten, MD: Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
Matthew Weiss, MD: Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
William Burns, MD: Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
Jun Yu, MD, PhD: Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
John Cameron, MD: Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
Johann Pratschke, MD: Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Surgery (CCM/CVK), Berlin, Germany
Christopher Lee Wolfgang, MD, PhD: Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
Jin He, MD, PhD: Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA
Richard Andrew Burkhart, MD: Johns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USA; Corresponding Author at: Johns Hopkins Hospital, 600 N Wolfe St, Blalock 685, Baltimore, MD 21287. Tel.: +1 410 955 8500; fax: +1 443 769 1276.

Journal volume & issue: Vol. 2, no. 4
pp. 32 – 40

Abstract

Read online

Background: Prolonged survival of patients after pancreaticoduodenectomy can be associated with late complications due to altered gastrointestinal anatomy. The incidence of gastric cancer is increasingly reported. We set out to examine our experience with gastric cancer as a late complication after pancreaticoduodenectomy with a focus on incidence, risk factors, and outcomes. Methods: We queried our prospectively collected institutional database for patients that developed gastric cancer after pancreaticoduodenectomy and conducted a systematic review of the literature. Results: Our database revealed 6 patients who developed gastric cancer following pancreaticoduodenectomy, presenting with a mean age of 62.2 years and an even sex distribution. All of those patients underwent pancreaticoduodenectomy for malignant indications with an average time to development of metachronous gastric cancer of 8.3 years. Four patients complained of gastrointestinal discomfort prior to diagnosis of secondary malignancy. All of these cancers were poorly differentiated and were discovered at an advanced T stage (≥3). Only half developed at the gastrointestinal anastomosis. Four underwent surgery with a curative intent, and 2 patients are currently alive (mean postgastrectomy survival = 25.5 months). In accordance with previous literature, biliopancreatic reflux from pancreaticoduodenectomy reconstruction, underlying genetic susceptibility, and adjuvant therapy may play a causative role in later development of gastric cancer. Conclusion: Long-term survivors after pancreaticoduodenectomy who develop nonspecific gastrointestinal complaints should be evaluated carefully for complications including gastric malignancy. This may serve as an opportunity to intervene on tumors that typically present at an advanced stage and with aggressive histology.

Published in Surgery Open Science

ISSN: 2589-8450 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://www.journals.elsevier.com/surgery-open-science/

About the journal