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

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...

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Main Authors:	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
Format:	Article
Language:	English
Published:	Elsevier 2020-10-01
Series:	Surgery Open Science
Online Access:	http://www.sciencedirect.com/science/article/pii/S258984502030021X

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collection	DOAJ
language	English
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sources	DOAJ
author	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
spellingShingle	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 Gastric cancer following pancreaticoduodenectomy: Experience from a high-volume center and review of existing literature Surgery Open Science
author_facet	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
author_sort	Michael Johannes Pflüger, MD
title	Gastric cancer following pancreaticoduodenectomy: Experience from a high-volume center and review of existing literature
title_short	Gastric cancer following pancreaticoduodenectomy: Experience from a high-volume center and review of existing literature
title_full	Gastric cancer following pancreaticoduodenectomy: Experience from a high-volume center and review of existing literature
title_fullStr	Gastric cancer following pancreaticoduodenectomy: Experience from a high-volume center and review of existing literature
title_full_unstemmed	Gastric cancer following pancreaticoduodenectomy: Experience from a high-volume center and review of existing literature
title_sort	gastric cancer following pancreaticoduodenectomy: experience from a high-volume center and review of existing literature
publisher	Elsevier
series	Surgery Open Science
issn	2589-8450
publishDate	2020-10-01
description	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.
url	http://www.sciencedirect.com/science/article/pii/S258984502030021X
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spelling	doaj-87f30919193b48a3b622672bab8040602020-11-25T01:19:49ZengElsevierSurgery Open Science2589-84502020-10-01243240Gastric cancer following pancreaticoduodenectomy: Experience from a high-volume center and review of existing literatureMichael Johannes Pflüger, MD0Matthäus Felsenstein, MD1Ryan Schmocker, MD2Laura DeLong Wood, MD, PhD3Ralph Hruban, MD4Kohei Fujikura, MD, PhD5Noah Rozich, MD6Floortje van Oosten, MD7Matthew Weiss, MD8William Burns, MD9Jun Yu, MD, PhD10John Cameron, MD11Johann Pratschke, MD12Christopher Lee Wolfgang, MD, PhD13Jin He, MD, PhD14Richard Andrew Burkhart, MD15Johns 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, GermanyJohns 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, GermanyJohns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USAJohns Hopkins School of Medicine, Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Baltimore, MD, USAJohns Hopkins School of Medicine, Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Baltimore, MD, USAJohns Hopkins School of Medicine, Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Baltimore, MD, USAJohns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USAJohns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USAJohns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USAJohns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USAJohns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USAJohns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USACharité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Surgery (CCM/CVK), Berlin, GermanyJohns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USAJohns Hopkins Hospital, Department of Surgery, Hepatobiliary and Pancreatic Surgery Section of the Division of Surgical Oncology, Baltimore, MD, USAJohns 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.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.http://www.sciencedirect.com/science/article/pii/S258984502030021X

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

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