Is the resected stomach a premalignant condition?

A retrospective study of 162 patients with carcinoma of the gastric stump showed the 5-year survival rate to be 3.7%. Data were collected on 2633 patients subjected to gastric surgery between 1931 and 1960. The causes of death of 741 of these patients, all of whom had died longer than 5 years after the operation were traced: 38 patients (5.13%) were found to have died from carcinoma of the gastric stump. Of the surviving patients, 504 were subjected to endoscopic examination with biopsy. Up to the time of writing, gastric stump carcinoma had been discovered in 10 patients (1.98%). Three patients died within 2 years; in 7, radical and curative surgery was possible and these are still alive. In 3 patients in whom the earlier examination had led to the diagnosis of severe dysplasia, the extended examination revealed the carcinoma of the gastric stump. Cell-kinetic examination of 60 patients who had undergone a Billroth-II resection also yielded indications of the premalignant character of the resected stomach and corroborated the view that the surgical intervention is of importance with regard to the carcinogenesis of the gastric stump. It is concluded that the resected stomach should be regarded as a premalignant condition; that early diagnosis of the resected stomach is quite feasible but that its precise importance for the prognosis of the disease in the individual patient is difficult to determine; that severe dysplasia of gastric epithelium constitutes a genuine premalignant lesion.