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. 1989 Aug;210(2):159–164. doi: 10.1097/00000658-198908000-00004

Gastric cancer after peptic ulcer surgery. A historic prospective cohort investigation.

C Toftgaard 1
PMCID: PMC1357821  PMID: 2757419

Abstract

In a historical prospective cohort investigation of 4131 patients undergoing peptic ulcer surgery in 53 hospitals in the western part of Denmark from 1955 through 1960, the risk of subsequent gastric cancer development was studied. The patients were followed with regard to gastric cancer development until their death or the end of the year 1982 and the incidence of cancer in this cohort was compared to the incidence in the total population in the same region during the same period. A total of 46 gastric cancers were diagnosed versus 47 expected. Up to 15 years after operation the cancer risk was lower than expected. After 15 years the risk was higher than expected with a 2.1-fold higher incidence after 25 years for the total patient population. The highest risk was observed in male subjects undergoing a Billroth II subtotal gastrectomy with a 3.2 times increase in risk after 25 years. There was no difference between gastric and duodenal ulcer patients; and patients undergoing simple suture for a perforated ulcer showed no increase in cancer incidence. Patients with long-lasting symptoms had the same incidence as patients with briefer symptoms. These observations indicate that the operation per se and not the ulcer disease may be precancerous.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Balfour D. C. LIFE EXPECTANCY OF PATIENTS FOLLOWING OPERATIONS FOR GASTRIC AND DUODENAL ULCER. Ann Surg. 1919 Nov;70(5):522–525. doi: 10.1097/00000658-191911000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Caygill C. P., Hill M. J., Kirkham J. S., Northfield T. C. Mortality from gastric cancer following gastric surgery for peptic ulcer. Lancet. 1986 Apr 26;1(8487):929–931. doi: 10.1016/s0140-6736(86)91041-x. [DOI] [PubMed] [Google Scholar]
  3. Cheli R., Santi L., Ciancamerla G., Canciani G. A clinical and statistical follow-up study of atrophic gastritis. Am J Dig Dis. 1973 Dec;18(12):1061–1065. doi: 10.1007/BF01076522. [DOI] [PubMed] [Google Scholar]
  4. Fischer A. B., Graem N., Jensen O. M. Risk of gastric cancer after Billroth II resection for duodenal ulcer. Br J Surg. 1983 Sep;70(9):552–554. doi: 10.1002/bjs.1800700915. [DOI] [PubMed] [Google Scholar]
  5. HELSINGEN N., HILLESTAD L. Cancer development in the gastric stump after partial gastrectomy for ulcer. Ann Surg. 1956 Feb;143(2):173–179. doi: 10.1097/00000658-195614320-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Hellers G., Ewerth S., Ost A. Cancer i ventrikelstumpen efter tidigare resektion för benignt ulcus. Lakartidningen. 1981 Sep 23;78(39):3392–3394. [PubMed] [Google Scholar]
  7. Houghton P. W., Mortensen N. J., Williamson R. C. Effect of duodenogastric reflux on gastric mucosal proliferation after gastric surgery. Br J Surg. 1987 Apr;74(4):288–291. doi: 10.1002/bjs.1800740421. [DOI] [PubMed] [Google Scholar]
  8. Jensen O. M., Storm H. H., Jensen H. S. Cancer registration in Denmark and the study of multiple primary cancers, 1943-80. Natl Cancer Inst Monogr. 1985 Dec;68:245–251. [PubMed] [Google Scholar]
  9. KUHLMAYER R., ROKITANSKY O. Das Magenstumpfcarcinom als Spätproblem der Ulcuschirurgie. Langenbecks Arch Klin Chir Ver Dtsch Z Chir. 1954;278(4):361–375. [PubMed] [Google Scholar]
  10. Kivilaakso E., Hakkiluoto A., Kalima T. V., Sipponen P. Relative risk of stump cancer following partial gastrectomy. Br J Surg. 1977 May;64(5):336–338. doi: 10.1002/bjs.1800640510. [DOI] [PubMed] [Google Scholar]
  11. Klarfeld J., Resnick G. Gastric remnant carcinoma. Cancer. 1979 Sep;44(3):1129–1133. doi: 10.1002/1097-0142(197909)44:3<1129::aid-cncr2820440349>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  12. Langhans P., Heger R. A., Hohenstein J., Bünte H. Gastric stump carcinoma--new aspects deduced from experimental results. Scand J Gastroenterol Suppl. 1981;67:161–164. [PubMed] [Google Scholar]
  13. Lund E. Stumpcancer i Norge 1970-1979. Diagnostisk eller reell økning? Tidsskr Nor Laegeforen. 1983 Mar 20;103(8-9):765–767. [PubMed] [Google Scholar]
  14. Monson R. R. Analysis of relative survival and proportional mortality. Comput Biomed Res. 1974 Aug;7(4):325–332. doi: 10.1016/0010-4809(74)90010-x. [DOI] [PubMed] [Google Scholar]
  15. Morgenstern L. Vagotomy, gastroenterostomy and experimental gastic cancer. Arch Surg. 1968 Jun;96(6):920–923. doi: 10.1001/archsurg.1968.01330240066014. [DOI] [PubMed] [Google Scholar]
  16. Mosimann F., Sorgi M., Wolverson R. L., Donovan I. A., Fielding J. W., Harding L. K., Alexander-Williams J., Thompson H. Gastric histology and its relationship to entero-gastric reflux after duodenal ulcer surgery. Scand J Gastroenterol Suppl. 1984;92:142–144. [PubMed] [Google Scholar]
  17. Muscroft T. J., Deane S. A., Youngs D., Burdon D. W., Keighley M. R. The microflora of the postoperative stomach. Br J Surg. 1981 Aug;68(8):560–564. doi: 10.1002/bjs.1800680813. [DOI] [PubMed] [Google Scholar]
  18. Nicholls J. C. Carcinoma of the stomach following partial gastrectomy for benign gastroduodenal lesions. Br J Surg. 1974 Mar;61(3):244–249. doi: 10.1002/bjs.1800610319. [DOI] [PubMed] [Google Scholar]
  19. ORRINGER D. Carcinoma of the stomach following surgery for chronic duodenal ulcer. Surgery. 1950 Oct;28(4):680–683. [PubMed] [Google Scholar]
  20. Offerhaus G. J., Huibregtse K., de Boer J., Verhoeven T., van Olffen G. H., van de Stadt J., Tytgat G. N. The operated stomach: a premalignant condition? A prospective endoscopic follow-up study. Scand J Gastroenterol. 1984 Jun;19(4):521–524. [PubMed] [Google Scholar]
  21. Osterlind A., Jensen O. M. Evaluering af cancerregistreringen i Danmark 1977. En praeliminaer evaluering af cancerregisterets og landspatientregisterets registrering af cancertilfaelde. Ugeskr Laeger. 1985 Jul 29;147(31):2483–2488. [PubMed] [Google Scholar]
  22. PACK G. T., BANNER R. L. The late development of gastric cancer after gastroenterostomy and gastrectomy for peptic ulcer and benign pyloric stenosis. Surgery. 1958 Dec;44(6):1024–1033. [PubMed] [Google Scholar]
  23. Papachristou D. N., Agnanti N., Fortner J. G. Gastric carcinoma after treatment of ulcer. Am J Surg. 1980 Feb;139(2):193–196. doi: 10.1016/0002-9610(80)90252-4. [DOI] [PubMed] [Google Scholar]
  24. Reed P. I., Smith P. L., Summers K., Haines K., Burgess B. A., House F. R., Walters C. L. The influence of enterogastric reflux on gastric juice bacterial growth, nitrite, and N-nitroso compound concentrations following gastric surgery. Scand J Gastroenterol Suppl. 1984;92:232–234. [PubMed] [Google Scholar]
  25. Schlag P., Weber E., Meister H., Meyer H. Tierexperimentelle Untersuchungen zur Carcinomgefährdung des Magens nach Vagotomie. Langenbecks Arch Chir. 1982;357(2):105–116. doi: 10.1007/BF01237456. [DOI] [PubMed] [Google Scholar]
  26. Schrumpf E., Serck-Hanssen A., Stadaas J., Aune S., Myren J., Osnes M. Mucosal changes in the gastric stump 20-25 years after partial gastrectomy. Lancet. 1977 Sep 3;2(8036):467–469. doi: 10.1016/s0140-6736(77)91599-9. [DOI] [PubMed] [Google Scholar]
  27. Siurala M., Lehtola J., Ihamäki T. Atrophic gastritis and its sequelae. Results of 19-23 years' follow-up examinations. Scand J Gastroenterol. 1974;9(5):441–446. [PubMed] [Google Scholar]
  28. Stalsberg H., Taksdal S. Stomach cancer following gastric surgery for benign conditions. Lancet. 1971 Nov 27;2(7735):1175–1177. doi: 10.1016/s0140-6736(71)90489-2. [DOI] [PubMed] [Google Scholar]
  29. Stokkeland M., Schrumpf E., Hanssen A. S., Myren J., Osnes M., Stadaas J. Incidence of malignancies of the Billroth II operated stomach. A prospective follow-up. Scand J Gastroenterol Suppl. 1981;67:169–171. [PubMed] [Google Scholar]
  30. Tokudome S., Kono S., Ikeda M., Kuratsune M., Sano C., Inokuchi K., Kodama Y., Ichimiya H., Nakayama F., Kaibara N. A prospective study on primary gastric stump cancer following partial gastrectomy for benign gastroduodenal diseases. Cancer Res. 1984 May;44(5):2208–2212. [PubMed] [Google Scholar]
  31. Viste A., Bjørnestad E., Opheim P., Skarstein A., Thunold J., Hartveit F., Eide G. E., Eide T. J., Søreide O. Risk of carcinoma following gastric operations for benign disease. A historical cohort study of 3470 patients. Lancet. 1986 Aug 30;2(8505):502–505. doi: 10.1016/s0140-6736(86)90368-5. [DOI] [PubMed] [Google Scholar]
  32. Watt P. C., Sloan J. M., Kennedy T. L. Changes in gastric mucosa after vagotomy and gastrojejunostomy for duodenal ulcer. Br Med J (Clin Res Ed) 1983 Nov 12;287(6403):1407–1410. doi: 10.1136/bmj.287.6403.1407. [DOI] [PMC free article] [PubMed] [Google Scholar]

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