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. 1994 Jul;35(7):946–949. doi: 10.1136/gut.35.7.946

Gastric cancer risk after vagotomy.

G Lundegårdh 1, A Ekbom 1, J K McLaughlin 1, O Nyrén 1
PMCID: PMC1374842  PMID: 8063222

Abstract

The risk of gastric cancer after vagotomy for benign gastric and duodenal disease was examined in a population based cohort of 7198 patients operated on during 1971-79 and followed up until 1988. After exclusion of the first year of follow up there were 34 cases of gastric cancer compared with 25.6 expected (standardised incidence ratio (SIR) = 1.33; 95% confidence intervals (CI) 0.92 to 1.86). Separate analyses by duration of follow up, sex, age at operation, underlying diagnosis, and operative procedures did not show any significant increased or decreased risk of gastric cancer in any of the subgroups. In conclusion, decreased gastric acid secretion after vagotomy does not increase the risk of gastric cancer in the first 10 years after operation or in the subgroup followed up for 10-18 years. A longer follow-up is needed before an excess risk can be excluded.

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Selected References

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  1. Armitage J. O., Sidner R. D. Antitumour effect of cimetidine. Lancet. 1979 Apr 21;1(8121):882–883. doi: 10.1016/s0140-6736(79)91306-0. [DOI] [PubMed] [Google Scholar]
  2. 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]
  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. Caygill C. P., Knowles R. L., Hall R. Increased risk of cancer mortality after vagotomy for peptic ulcer: a preliminary analysis. Eur J Cancer Prev. 1991 Oct;1(1):35–37. doi: 10.1097/00008469-199110000-00007. [DOI] [PubMed] [Google Scholar]
  5. Colin-Jones D. G., Langman M. J., Lawson D. H., Vessey M. P. Postmarketing surveillance of the safety of cimetidine: mortality during second, third, and fourth years of follow up. Br Med J (Clin Res Ed) 1985 Oct 19;291(6502):1084–1088. doi: 10.1136/bmj.291.6502.1084. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Ditlevsen S. Survival after vagotomy: results of the Aarhus County Vagotomy Trial. World J Surg. 1989 Nov-Dec;13(6):776–781. doi: 10.1007/BF01658433. [DOI] [PubMed] [Google Scholar]
  7. Flodgren P., Borgström S., Jönsson P. E., Lindström C., Sjögren H. O. Metastatic malignant melanoma: regression induced by combined treatment with interferon [HuIFN-alpha(Le)] and cimetidine. Int J Cancer. 1983 Dec 15;32(6):657–665. doi: 10.1002/ijc.2910320603. [DOI] [PubMed] [Google Scholar]
  8. Forman D., Newell D. G., Fullerton F., Yarnell J. W., Stacey A. R., Wald N., Sitas F. Association between infection with Helicobacter pylori and risk of gastric cancer: evidence from a prospective investigation. BMJ. 1991 Jun 1;302(6788):1302–1305. doi: 10.1136/bmj.302.6788.1302. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Fujita M., Takami M., Usugane M., Nampei S., Taguchi T. Enhancement of gastric carcinogenesis in dogs given N-methyl-N'-nitro-N-nitrosoguanidine following vagotomy. Cancer Res. 1979 Mar;39(3):811–816. [PubMed] [Google Scholar]
  10. Gustavsson S., Nyrén O. Time trends in peptic ulcer surgery, 1956 to 1986. A nation-wide survey in Sweden. Ann Surg. 1989 Dec;210(6):704–709. doi: 10.1097/00000658-198912000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hansson L. E., Engstrand L., Nyrén O., Evans D. J., Jr, Lindgren A., Bergström R., Andersson B., Athlin L., Bendtsen O., Tracz P. Helicobacter pylori infection: independent risk indicator of gastric adenocarcinoma. Gastroenterology. 1993 Oct;105(4):1098–1103. doi: 10.1016/0016-5085(93)90954-b. [DOI] [PubMed] [Google Scholar]
  12. Howson C. P., Hiyama T., Wynder E. L. The decline in gastric cancer: epidemiology of an unplanned triumph. Epidemiol Rev. 1986;8:1–27. doi: 10.1093/oxfordjournals.epirev.a036288. [DOI] [PubMed] [Google Scholar]
  13. Hsing A. W., Hansson L. E., McLaughlin J. K., Nyren O., Blot W. J., Ekbom A., Fraumeni J. F., Jr Pernicious anemia and subsequent cancer. A population-based cohort study. Cancer. 1993 Feb 1;71(3):745–750. doi: 10.1002/1097-0142(19930201)71:3<745::aid-cncr2820710316>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
  14. Jorde R., Johnson J. A., Bostad L. H., Burhol P. G. An endoscopic study of ulcer recurrence and mucosal changes following vagotomy and excision of gastric ulcer. Acta Chir Scand. 1987 Apr;153(4):297–302. [PubMed] [Google Scholar]
  15. Junghanns K., Seufert R., von Gerstenbergk L., Ivankovic S. Does vagotomy and pyloroplasty change the location of gastrointestinal tumors? World J Surg. 1979 Aug 31;3(4):497–499. doi: 10.1007/BF01556116. [DOI] [PubMed] [Google Scholar]
  16. Jönsson K. A., Ström M., Bodemar G., Norrby K. Histologic changes in the gastroduodenal mucosa after long-term medical treatment with cimetidine or parietal cell vagotomy in patients with juxtapyloric ulcer disease. Scand J Gastroenterol. 1988 May;23(4):433–441. doi: 10.3109/00365528809093891. [DOI] [PubMed] [Google Scholar]
  17. Kowalewski K. Relationship between vagotomy, peptic ulcer and gastric adenocarcinoma in rats fed 2,7-diacetylaminogluorene. Can J Surg. 1973 May;16(3):210–217. [PubMed] [Google Scholar]
  18. La Vecchia C., Negri E., D'Avanzo B., Franceschi S. Histamine-2-receptor antagonists and gastric cancer risk. Lancet. 1990 Aug 11;336(8711):355–357. doi: 10.1016/0140-6736(90)91888-h. [DOI] [PubMed] [Google Scholar]
  19. Lind T., Cederberg C., Olausson M., Olbe L. 24-hour intragastric acidity and plasma gastrin after omeprazole treatment and after proximal gastric vagotomy in duodenal ulcer patients. Gastroenterology. 1990 Dec;99(6):1593–1598. doi: 10.1016/0016-5085(90)90462-a. [DOI] [PubMed] [Google Scholar]
  20. 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]
  21. Marshall M. E., Mendelsohn L., Butler K., Riley L., Cantrell J., Wiseman C., Taylor R., Macdonald J. S. Treatment of metastatic renal cell carcinoma with coumarin (1,2-benzopyrone) and cimetidine: a pilot study. J Clin Oncol. 1987 Jun;5(6):862–866. doi: 10.1200/JCO.1987.5.6.862. [DOI] [PubMed] [Google Scholar]
  22. 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]
  23. Mori H., Domellöf L., Weisburger J. H., Williams G. M. Enhancing effect of vagotomy and pyloroplasty on gastro-intestinal carcinogenesis induced by nitrosamide in hamsters. Gan. 1981 Jun;72(3):440–445. [PubMed] [Google Scholar]
  24. Møller H., Lindvig K., Klefter R., Mosbech J., Møller Jensen O. Cancer occurrence in a cohort of patients treated with cimetidine. Gut. 1989 Nov;30(11):1558–1562. doi: 10.1136/gut.30.11.1558. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Møller H., Nissen A., Mosbech J. Use of cimetidine and other peptic ulcer drugs in Denmark 1977-1990 with analysis of the risk of gastric cancer among cimetidine users. Gut. 1992 Sep;33(9):1166–1169. doi: 10.1136/gut.33.9.1166. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Naessén T., Parker R., Persson I., Zack M., Adami H. O. Time trends in incidence rates of first hip fracture in the Uppsala Health Care Region, Sweden, 1965-1983. Am J Epidemiol. 1989 Aug;130(2):289–299. doi: 10.1093/oxfordjournals.aje.a115335. [DOI] [PubMed] [Google Scholar]
  27. Nomura A., Stemmermann G. N., Chyou P. H., Kato I., Perez-Perez G. I., Blaser M. J. Helicobacter pylori infection and gastric carcinoma among Japanese Americans in Hawaii. N Engl J Med. 1991 Oct 17;325(16):1132–1136. doi: 10.1056/NEJM199110173251604. [DOI] [PubMed] [Google Scholar]
  28. O'Connor H. J., Dixon M. F., Wyatt J. I., Axon A. T., Ward D. C., Dewar E. P., Johnston D. Effect of duodenal ulcer surgery and enterogastric reflux on Campylobacter pyloridis. Lancet. 1986 Nov 22;2(8517):1178–1181. doi: 10.1016/s0140-6736(86)92193-8. [DOI] [PubMed] [Google Scholar]
  29. 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]
  30. Osband M. E., Hamilton D., Shen Y. J., Cohen E., Shlesinger M., Lavin P., Brown A., McCaffrey R. Successful tumour immunotherapy with cimetidine in mice. Lancet. 1981 Mar 21;1(8221):636–638. doi: 10.1016/s0140-6736(81)91554-3. [DOI] [PubMed] [Google Scholar]
  31. 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]
  32. Schumacher M. C., Jick S. S., Jick H., Feld A. D. Cimetidine use and gastric cancer. Epidemiology. 1990 May;1(3):251–254. doi: 10.1097/00001648-199005000-00012. [DOI] [PubMed] [Google Scholar]
  33. Sharma B. K., Santana I. A., Wood E. C., Walt R. P., Pereira M., Noone P., Smith P. L., Walters C. L., Pounder R. E. Intragastric bacterial activity and nitrosation before, during, and after treatment with omeprazole. Br Med J (Clin Res Ed) 1984 Sep 22;289(6447):717–719. doi: 10.1136/bmj.289.6447.717. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Sipponen P., Kosunen T. U., Valle J., Riihelä M., Seppälä K. Helicobacter pylori infection and chronic gastritis in gastric cancer. J Clin Pathol. 1992 Apr;45(4):319–323. doi: 10.1136/jcp.45.4.319. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Stockbrugger R. W., Cotton P. B., Eugenides N., Bartholomew B. A., Hill M. J., Walters C. L. Intragastric nitrites, nitrosamines, and bacterial overgrowth during cimetidine treatment. Gut. 1982 Dec;23(12):1048–1054. doi: 10.1136/gut.23.12.1048. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Talley N. J., Zinsmeister A. R., Weaver A., DiMagno E. P., Carpenter H. A., Perez-Perez G. I., Blaser M. J. Gastric adenocarcinoma and Helicobacter pylori infection. J Natl Cancer Inst. 1991 Dec 4;83(23):1734–1739. doi: 10.1093/jnci/83.23.1734. [DOI] [PubMed] [Google Scholar]
  37. Tatsuta M., Iishi H., Yamamura H., Baba M., Taniguchi H. Effects of bilateral and unilateral vagotomy on gastric carcinogenesis induced by N-methyl-N'-nitro-N-nitrosoguanidine in Wistar rats. Int J Cancer. 1988 Sep 15;42(3):414–418. doi: 10.1002/ijc.2910420318. [DOI] [PubMed] [Google Scholar]
  38. Tatsuta M., Yamamura H., Iishi H., Ichii M., Noguchi S., Baba M., Taniguchi H. Promotion by vagotomy of gastric carcinogenesis induced by N-methyl-N'-nitro-N-nitrosoguanidine in Wistar rats. Cancer Res. 1985 Jan;45(1):194–197. [PubMed] [Google Scholar]
  39. Taylor D. N., Blaser M. J. The epidemiology of Helicobacter pylori infection. Epidemiol Rev. 1991;13:42–59. doi: 10.1093/oxfordjournals.epirev.a036078. [DOI] [PubMed] [Google Scholar]
  40. 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]
  41. Tønnesen H., Knigge U., Bülow S., Damm P., Fischerman K., Hesselfeldt P., Hjortrup A., Pedersen I. K., Pedersen V. M., Siemssen O. J. Effect of cimetidine on survival after gastric cancer. Lancet. 1988 Oct 29;2(8618):990–992. doi: 10.1016/s0140-6736(88)90743-x. [DOI] [PubMed] [Google Scholar]
  42. 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]
  43. 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]
  44. Watt P. C., Sloan J. M., Donaldson J. D., Patterson C. C., Kennedy T. L. Relationship between histology and gastric juice pH and nitrite in the stomach after operation for duodenal ulcer. Gut. 1984 Mar;25(3):246–252. doi: 10.1136/gut.25.3.246. [DOI] [PMC free article] [PubMed] [Google Scholar]

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