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Clinicopathologic features of remnant gastric cancer over time following distal gastrectomy. AIM: To investigate remnant gastric cancer (RGC) at various times after gastrectomy, and lay a foundation for the management of RGC. METHODS: Sixty-five patients with RGC > 2 years and < 10 years after gastrectomy (RGC I) and forty-nine with RGC > 10 years after gastrectomy (RGC II) who underwent curative surgery were enrolled in the study. The clinicopathologic factors, surgical outcomes, and prognosis were compared between RGC I and RGC II. RESULTS: There was no significant difference in surgical outcomes between RGC I and RGC II. For patients reconstructed with Billroth II, significantly more patients were RGC II compared with RGC (71.9% vs 21.2%, P < 0.001), and more RGC II patients had anastomotic site locations compared to RGC I (31.0% vs 56.3%, P = 0.038). The five-year survival rates for the patients with RGC I and RGC II were 37.6% and 47.9%, respectively, but no significant difference was observed. Borrmann type and tumor stage were confirmed to be independent prognostic factors in both groups. CONCLUSION: RGC II is located on the anastomotic site in higher frequency and more cases develop after Billroth II reconstruction than RGC I.