Skip to main content
NCBI home page
Gut logoLink to Gut
. 1994 Apr;35(4):451–454. doi: 10.1136/gut.35.4.451

Death from malignant disease after surgery for duodenal ulcer.

I M Macintyre 1, F O'Brien 1
PMCID: PMC1374789  PMID: 7695679

Abstract

A total of 2241 patients who had an operation for duodenal ulcer between 1947 and 1968 were followed up to determine the cause of death and to compare the observed number of deaths with the expected. Death certificates were traced for 1251 of 1387 known to have died. Observed deaths from all causes were significantly greater than expected (O/E 1.13) (95% CI 1.08 to 1.20). This was because of significant increases in deaths from neoplasms (O/E 1.25) (95% CI 1.13 to 1.39) and digestive diseases (O/E 1.71) (95% CI 1.11 to 2.59). Analysis of deaths from malignant disease showed an excess of deaths from carcinoma of lung (O/E 1.37) (95% CI 1.14 to 1.62) and from smoking related cancers (O/E 1.32) (95% CI 1.13 to 1.52) but there was no significant excess mortality from any other neoplasm. An excess of deaths within one year of the operation was seen from circulatory disease (O/E 1.85) (95% CI 1.17 to 2.78), respiratory disease (O/E 3.56) (95% CI 1.78 to 6.37), and digestive disease (O/E 21.46) (95% CI 13.75 to 31.93). These deaths are concentrated in the first postoperative month and as there is no excess mortality from circulatory, respiratory or digestive disease between 1 and 20 years postoperatively, show the direct effects of the operation as a cause of death. This together with the excess mortality from all respiratory disease confirms that excess mortality after duodenal ulcer surgery is, in the short term, the result of the operation itself and in the long term largely attributable to cigarette smoking. Operations for gastric ulcer largely account for the subsequent excess mortality from gastric cancer reported after peptic ulcer surgery. The findings do not support the theory that the operation has carcinogenic effects and do not support the case for routine endoscopic screening after operations for duodenal ulcer.

Full text

PDF
451

Selected References

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

  1. Arnthorsson G., Tulinius H., Egilsson V., Sigvaldason H., Magnusson B., Thorarinsson H. Gastric cancer after gastrectomy. Int J Cancer. 1988 Sep 15;42(3):365–367. doi: 10.1002/ijc.2910420310. [DOI] [PubMed] [Google Scholar]
  2. Caygill C. P., Hill M. J., Hall C. N., Kirkham J. S., Northfield T. C. Increased risk of cancer at multiple sites after gastric surgery for peptic ulcer. Gut. 1987 Aug;28(8):924–928. doi: 10.1136/gut.28.8.924. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. 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]
  4. Clark C. G., Ward M. W., McDonald A. M., Tovey F. I. The incidence of gastric stump cancer. World J Surg. 1983 Mar;7(2):236–240. doi: 10.1007/BF01656150. [DOI] [PubMed] [Google Scholar]
  5. Coleman M., Douglas A., Hermon C., Peto J. Cohort study analysis with a FORTRAN computer program. Int J Epidemiol. 1986 Mar;15(1):134–137. doi: 10.1093/ije/15.1.134. [DOI] [PubMed] [Google Scholar]
  6. Correa P., Haenszel W., Cuello C., Zavala D., Fontham E., Zarama G., Tannenbaum S., Collazos T., Ruiz B. Gastric precancerous process in a high risk population: cohort follow-up. Cancer Res. 1990 Aug 1;50(15):4737–4740. [PubMed] [Google Scholar]
  7. Doll R., Peto R. Mortality in relation to smoking: 20 years' observations on male British doctors. Br Med J. 1976 Dec 25;2(6051):1525–1536. doi: 10.1136/bmj.2.6051.1525. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Domellöf L., Janunger K. G. The risk for gastric carcinoma after partial gastrectomy. Am J Surg. 1977 Nov;134(5):581–584. doi: 10.1016/0002-9610(77)90439-1. [DOI] [PubMed] [Google Scholar]
  9. 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]
  10. Forman D., Sitas F., Newell D. G., Stacey A. R., Boreham J., Peto R., Campbell T. C., Li J., Chen J. Geographic association of Helicobacter pylori antibody prevalence and gastric cancer mortality in rural China. Int J Cancer. 1990 Oct 15;46(4):608–611. doi: 10.1002/ijc.2910460410. [DOI] [PubMed] [Google Scholar]
  11. 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]
  12. Johnsen R., Bernersen B., Straume B., Førde O. H., Bostad L., Burhol P. G. Prevalences of endoscopic and histological findings in subjects with and without dyspepsia. BMJ. 1991 Mar 30;302(6779):749–752. doi: 10.1136/bmj.302.6779.749. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. KRAUSE U. Late prognosis after partial gastrectomy for ulcer; a follow-up study of 361 patients operated upon from 1905 to 1933. Acta Chir Scand. 1958 Apr 15;114(5):341–354. [PubMed] [Google Scholar]
  14. LIAVAAG K. Cancer development in gastric stump after partial gastrectomy for peptic ulcer. Ann Surg. 1962 Jan;155:103–106. doi: 10.1097/00000658-196201000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Logan R. F., Langman M. J. Screening for gastric cancer after gastric surgery. Lancet. 1983 Sep 17;2(8351):667–670. doi: 10.1016/s0140-6736(83)92541-2. [DOI] [PubMed] [Google Scholar]
  16. Lundegårdh G., Adami H. O., Helmick C., Zack M., Meirik O. Stomach cancer after partial gastrectomy for benign ulcer disease. N Engl J Med. 1988 Jul 28;319(4):195–200. doi: 10.1056/NEJM198807283190402. [DOI] [PubMed] [Google Scholar]
  17. Macintyre I. M. Auditing outcome after gastro-intestinal operations--the evolution and work of a surgical review office. Health Bull (Edinb) 1988 Nov;46(6):307–310. [PubMed] [Google Scholar]
  18. Møller H., Toftgaard C. Cancer occurrence in a cohort of patients surgically treated for peptic ulcer. Gut. 1991 Jul;32(7):740–744. doi: 10.1136/gut.32.7.740. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Offerhaus G. J., Tersmette A. C., Giardiello F. M., Huibregtse K., Vandenbroucke J. P., Tytgat G. N. Evaluation of endoscopy for early detection of gastric-stump cancer. Lancet. 1992 Jul 4;340(8810):33–35. doi: 10.1016/0140-6736(92)92433-g. [DOI] [PubMed] [Google Scholar]
  20. Offerhaus G. J., Tersmette A. C., Huibregtse K., van de Stadt J., Tersmette K. W., Stijnen T., Hoedemaeker P. J., Vandenbroucke J. P., Tytgat G. N. Mortality caused by stomach cancer after remote partial gastrectomy for benign conditions: 40 years of follow up of an Amsterdam cohort of 2633 postgastrectomy patients. Gut. 1988 Nov;29(11):1588–1590. doi: 10.1136/gut.29.11.1588. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Ovaska J. T., Havia T. V., Kujari H. P. Risk of gastric stump carcinoma after gastric resection for benign ulcer disease. Ann Chir Gynaecol. 1986;75(4):192–195. [PubMed] [Google Scholar]
  22. Parsonnet J., Friedman G. D., Vandersteen D. P., Chang Y., Vogelman J. H., Orentreich N., Sibley R. K. Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med. 1991 Oct 17;325(16):1127–1131. doi: 10.1056/NEJM199110173251603. [DOI] [PubMed] [Google Scholar]
  23. Pickford I. R., Craven J. L., Hall R., Thomas G., Stone W. D. Endoscopic examination of the gastric remnant 31-39 years after subtotal gastrectomy for peptic ulcer. Gut. 1984 Apr;25(4):393–397. doi: 10.1136/gut.25.4.393. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Ross A. H., Smith M. A., Anderson J. R., Small W. P. Late mortality after surgery for peptic ulcer. N Engl J Med. 1982 Aug 26;307(9):519–522. doi: 10.1056/NEJM198208263070902. [DOI] [PubMed] [Google Scholar]
  25. Schafer L. W., Larson D. E., Melton L. J., 3rd, Higgins J. A., Ilstrup D. M. The risk of gastric carcinoma after surgical treatment for benign ulcer disease. A population-based study in Olmsted County, Minnesota. N Engl J Med. 1983 Nov 17;309(20):1210–1213. doi: 10.1056/NEJM198311173092003. [DOI] [PubMed] [Google Scholar]
  26. Sonnenberg A. Changes in physician visits for gastric and duodenal ulcer in the United States during 1958-1984 as shown by National Disease and Therapeutic Index (NDTI). Dig Dis Sci. 1987 Jan;32(1):1–7. doi: 10.1007/BF01296680. [DOI] [PubMed] [Google Scholar]
  27. Tersmette A. C., Offerhaus G. J., Tersmette K. W., Giardiello F. M., Moore G. W., Tytgat G. N., Vandenbroucke J. P. Meta-analysis of the risk of gastric stump cancer: detection of high risk patient subsets for stomach cancer after remote partial gastrectomy for benign conditions. Cancer Res. 1990 Oct 15;50(20):6486–6489. [PubMed] [Google Scholar]
  28. Toftgaard C. Gastric cancer after peptic ulcer surgery. A historic prospective cohort investigation. Ann Surg. 1989 Aug;210(2):159–164. doi: 10.1097/00000658-198908000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. 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]
  30. 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]
  31. Vogt T. M., Johnson R. E. Recent changes in the incidence of duodenal and gastric ulcer. Am J Epidemiol. 1980 Jun;111(6):713–720. doi: 10.1093/oxfordjournals.aje.a112949. [DOI] [PubMed] [Google Scholar]
  32. Watt P. C., Patterson C. C., Kennedy T. L. Late mortality after vagotomy and drainage for duodenal ulcer. Br Med J (Clin Res Ed) 1984 May 5;288(6427):1335–1338. doi: 10.1136/bmj.288.6427.1335. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Wylie C. M. The complex wane of peptic ulcer. I. Recent national trends in deaths and hospital care in the United States. J Clin Gastroenterol. 1981 Dec;3(4):327–332. doi: 10.1097/00004836-198112000-00006. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES