Objective  To investigate the association of lymphovascular invasion (LVI) with the clinicopathologic features and prognosis of gastric stump cancer.

  Methods  The clinical data of 208 patients with gastric stump cancer who received treatment (radical and palliative resection) from March 1999 to March 2020 in Fujian Medical University Cancer Hospital were analyzed. The patients were assigned into two groups according to whether the tumor demonstrated LVI; 118 patients were assigned to the tumor-with-LVI group and 90 to the tumor-without-LVI group. The clinicopathologic characteristics, lymph node metastasis, operative data, and prognostic differences were compared between the two groups.

  Results  LVI was correlated with the depth of invasion, lymph node metastasis, TNM stage, histological type, perineural invasion, and Borrmann classification (P<0.05). Multivariate analysis showed that perineural invasion, LVI, tumor size, TNM stage, and combined organ resection were independent risk factors for the prognosis of patients with gastric stump cancer (P<0.05). There were significant differences in the operative time and lymph node metastasis between the two groups (P<0.05). The 5-year overall survival rate of all included patients was 45.6%, being 28.8% and 66.0% for patients with gastric cancer with and without LVI, respectively. The difference was statistically significant between the two groups (P<0.05). In gastric stump cancer with tumor size ≥5 cm, TNM stage Ⅱ, and TNM stage Ⅲ, the 5-year overall survival rates of patients with and without LVI were 20.2% and 59.6%, 44.1% and 82.2%, and 19.9% and 42.7%, respectively. The difference was statistically significant between the two groups (P<0.05).

  Conclusions  LVI is an important index in determining the prognosis of patients with gastric stump cancer. Patients with LVI, especially those with tumor size ≥5 cm, TNM stage Ⅱ, or TNM stage Ⅲ, need more active adjuvant therapy.