Skip to main content
NCBI home page
Japanese Journal of Cancer Research : Gann logoLink to Japanese Journal of Cancer Research : Gann
. 1991 Mar;82(3):266–272. doi: 10.1111/j.1349-7006.1991.tb01841.x

Geographical Variance in the Risk of Gastric Stump Cancer: No Increased Risk in Japan?

Anne C Tersmette 1,†, Francis M Giardiello 2, G Johan A Offerhaus 3,✉, Kasper W F Tersmette 4, Kumiko Ohara 5, Jan P Vandenbroucke 1, Guido N J Tytgat 6
PMCID: PMC5918404  PMID: 1827091

Abstract

Geographical differences may exist in the risk of gastric stump cancer. Therefore, we performed meta‐analysis of literature reports in Japan (n=3), the USA (n=4), and Europe (n = 20) on the risk of postgastrectomy cancer. The weighted mean relative risk of stump cancer in Japan was 0.28, 95% confidence limits 0.21–0.38 as compared to 1.53, 95% confidence limits 0.98–2.41 in the USA and 1.66, 95% confidence limits 1.55–1.79 in Europe. Thus, the risk of gastric cancer in the postgastrectomy patient seems decreased in Japan and is significantly less than in the USA or Europe, where an increased risk exists. Since there is a high risk of gastric cancer of the intact stomach in Japan, the discovery of a low cancer risk in the gastric stump may provide evidence that these gastric cancers are two different entities.

Keywords: Gastric stump cancer, Geographical variance, Meta‐analysis, Relative risk

Full Text

The Full Text of this article is available as a PDF (383.1 KB).

REFERENCES

  • 1. ) Carter , D. C.Cancer after peptic ulcer surgery . Gut , 28 , 921 – 923 ( 1987. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2. ) Schafer , L. W. , Larson , D. E. , Melton , L. J. , Higgins , J. A. and 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. , 309 , 1210 – 1213 ( 1983. ). [DOI] [PubMed] [Google Scholar]
  • 3. ) Tokudome , S. , Kono , S. , Ikeda , M. , Kuratsune , M. , Sano , C. , Inokuchi , K. , Kodama , Y. , Ichimiya , H. , Nakayama , F. , Kaibara , N. , Koga , S. , Yamada , H. , Oka , N. and Tsurumaru , H.Primary gastric stump cancer following partial gastrectomy for benign gastroduodenal diseases . Stomach Intestine , 17 , 1295 – 1301 ( 1982. ). [PubMed] [Google Scholar]
  • 4. ) Light , R. J. and Pillemer , D. B. “ Summing up: the Science of Reviewing Research” ( 1984. ). Harvard Unversity Press; , Cambridge , MA . [Google Scholar]
  • 5. ) Greenland , S.Quantitative methods in the review of epidemiologic literature . Epidemiol. Rev. , 9 , 1 – 30 ( 1987. ). [DOI] [PubMed] [Google Scholar]
  • 6. ) Helsingen , N. and Hillestad , L.Cancer development in the gastric stump after partial gastrectomy for ulcer . Ann. Surg. , 143 , 173 – 179 ( 1956. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7. ) Tokudome , S. , Kono , S. , Ikeda , M. , Kuratsune , M. , Sano , C. , Inokuchi , K. , Kodama , Y. , Ichimiya , H. , Nakayama , F. , Kaibara , N. , Koga , S. , Yamada , H. , Oka , N. and Tsurumaru , H.A prospective study on primary gastric stump cancer following partial gastrectomy for benign gastroduodenal diseases . Cancer Res. , 44 , 2208 – 2212 ( 1984. ). [PubMed] [Google Scholar]
  • 8. ) Asano , A. , Mizuno , S. , Sasaki , R. , Aoki , K. , Yokoyama , H. and Yokoyama , Y.The long‐term prognosis of patients gastrectomized for benign gastroduodenal diseases , Jpn. J. Cancer Res. , 78 , 337 – 348 ( 1987. ). [PubMed] [Google Scholar]
  • 9. ) Yoshikawa , K.A study on the high risk group of stomach cancer from the standpoint of view on occupation mass screening . In“Annual Report of the Cancer Research, Ministry of Health and Welfare ”, pp. 443 – 445 ( 1977. ). National Cancer Center; , Tokyo ( in Japanese ). [Google Scholar]
  • 10. ) Hirohata , T.Mortality from gastric cancer and other causes after medical or surgical treatment for gastric ulcer . J. Nat. Cancer Inst. , 41 , 895 – 908 ( 1968. ). [PubMed] [Google Scholar]
  • 11. ) Papachristou , D. N. , Agnanti , N. and Fortner , G. J.Gastric carcinoma after treatment of ulcer . Am. J. Surg. , 139 , 193 – 196 ( 1980. ). [DOI] [PubMed] [Google Scholar]
  • 12. ) Sandier , R. S. , Johnson , M. D. and Holland , K. L.Risk of stomach cancer after gastric surgery for benign conditions. A case‐control study . Dig. Dis. Sci. , 29 , 703 – 708 ( 1984. ). [DOI] [PubMed] [Google Scholar]
  • 13. ) Kühlmayer , R. and Rokitansky , O.Das Magenstumpfkarzinom als Spätproblem der Ulcuschirurgie . LangenbecksArch. Chir. , 278 , 361 – 375 ( 1954. ). [PubMed] [Google Scholar]
  • 14. ) 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. , 144 , 341 – 354 ( 1957. ). [PubMed] [Google Scholar]
  • 15. ) Griesser , G. and Schmidt , H.Statistische Erhebungen über die Häufigkeit des Karzinoms nach Magenoperation wegen eines Geschwiirsleidens . Med. Welt , 35 , 1836 – 1840 ( 1964. ). [PubMed] [Google Scholar]
  • 16. ) Hilbe , G. , Salzer , G. M. , Hussl , H. and Kutschera , H.Die Karzinomgefährdung des Resektionsmagens . Langenbecks Arch. Klin. Chir. , 323 , 142 – 153 ( 1968. ). [DOI] [PubMed] [Google Scholar]
  • 17. ) Stalsberg , H. and Taksdal , S.Stomach cancer following gastric surgery for benign conditions . Lancet , ii , 1175 – 1177 ( 1971. ). [DOI] [PubMed] [Google Scholar]
  • 18. ) Domellöf , L. and Janunger , K. G.The risk for gastric carcinoma after partial gastrectomy . Am. J. Surg. , 134 , 581 – 584 ( 1977. ). [DOI] [PubMed] [Google Scholar]
  • 19. ) Kivilaakso , E. , Hakkiluoto , A. , Kalima , T. V. and Sipponen , P.Relative risk of stump cancer following partial gastrectomy . Br. J. Surg. , 64 , 336 – 338 ( 1977. ). [DOI] [PubMed] [Google Scholar]
  • 20. ) Peitsch , W. and Becker , H. D.Frequency and prognosis of gastric stump cancer . Front. Gastrointest. Res. , 5 , 170 – 177 ( 1979. ). [DOI] [PubMed] [Google Scholar]
  • 21. ) McLean Ross , A. H. , Smith , M. A. , Anderson , J. R. and Small , W. P.Late mortality after surgery for peptic ulcer . N. Engl. J. Med. , 307 , 519 – 522 ( 1982. ). [DOI] [PubMed] [Google Scholar]
  • 22. ) Fischer , A. B. , Graem , N. and Jensen , O. M.Risk of gastric cancer after Billroth II resection for duodenal ulcer . Br. J. Surg. , 70 , 552 – 554 ( 1983. ). [DOI] [PubMed] [Google Scholar]
  • 23. ) Clark , C. G. , Ward , M. W. N. , McDonald , A. M. and Tovey , F. I.The incidence of gastric stump cancer . World J. Surg. , 7 , 236 – 240 ( 1983. ). [DOI] [PubMed] [Google Scholar]
  • 24. ) Watt , P. C. H. , Patterson , C. C. and Kennedy , T. L.Late mortality after vagotomy and drainage for duodenal ulcer , Br. Med. J. , 288 , 1335 – 1338 ( 1984. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25. ) Caygill , C. P. J. , Hill , M. J. , Kirkham , J. S. and Northfield , T. C.Mortality from gastric cancer following gastric surgery for peptic ulcer . Lancet , i , 929 – 931 ( 1986. ). [DOI] [PubMed] [Google Scholar]
  • 26. ) Loscos , J. M. , del Olmo , A. G. , Nisa , E. , Baki , W. , Nazal , R. and Ramirez‐Armengol , J. A.Cancer of the gastric stump . Gastrointest. Endosc. , 32 , 75 – 77 ( 1986. ). [DOI] [PubMed] [Google Scholar]
  • 27. ) Viste , A. , Bjørnestad , E. , Opheim , P. , Skarstein , A. , Thunold , J. , Hartveit , F. , Eide , G. E. and Eide , T. J.Risk of carcinoma following gastric operations for benign disease. A historical cohort study of 3740 patients . Lancet , ii , 502 – 505 ( 1986. ). [DOI] [PubMed] [Google Scholar]
  • 28. ) Lundegårdh , G. , Adami , H. O. , Helmick , C. , Zack , M. and Meirik , O.Stomach cancer after partial gastrectomy for benign ulcer disease . N. Engl. J. Med. , 319 , 195 – 200 ( 1988. ). [DOI] [PubMed] [Google Scholar]
  • 29. ) Arnthorsson , G. , Tulinius , H. , Egilsson , V. , Sigvaldason , H. , Magnusson , B. and Thorarinsson , H.Gastric cancer after gastrectomy . Int. J. Cancer , 42 , 365 – 367 ( 1988. ). [DOI] [PubMed] [Google Scholar]
  • 30. ) Offerhaus , G. J. A. , Tersmette , A. C. , Huibregtse , K. v.d.Stadt , J. , Tersmette , K. W. F. , Stijnen , T. H. , Hoedemaeker , Ph. J. , Vandenbroucke , J. P. and Tytgat , G. N. J.Mortality caused by stomach cancer after remote partial gastrectomy for benign conditions: forty years of follow up of an Amsterdam cohort of 2633 post‐gastrectomy patients . Gut , 29 , 1588 – 1590 ( 1988. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31. ) Toftgaard , C.Gastric cancer after peptic ulcer surgery . Ann. Surg. , 210 , 159 – 164 ( 1989. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32. ) Offerhaus , G. J. A. , Termette , A. C.Tersmette , K. W. F. , Tytgat , G. N. J. , Hoedemaeker , Ph. J. and Vandenbroucke , J. P.Gastric, pancreatic, and colorectal carcinogenesis following remote peptic ulcer surgery. Review of the literature with the emphasis on risk assessment and underlying mechanism . Mod. Pathol. , 1 , 352 – 356 ( 1988. ). [PubMed] [Google Scholar]
  • 33. ) Tersmette , A. C. , Offerhaus , G. J. A. , Tersmette , K. W. F. , Giardiello , F. M. , Moore , G. W. , Tytgat , G. N. J. and 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. , 50 , 6486 – 6489 ( 1990. ). [PubMed] [Google Scholar]
  • 34. ) Woolfe , B.On estimating the relation between blood group and disease . Ann. Hum. Genet. , 10 , 251 – 253 ( 1955. ). [DOI] [PubMed] [Google Scholar]
  • 35. ) Ederer , F. and Mantel , N.Confidence limits on the ratio of two Poisson variables . Am. J. Epidemiol. , 100 , 165 – 167 ( 1974. ). [DOI] [PubMed] [Google Scholar]
  • 36. ) Vandenbroucke , J. P.Passive smoking and lung cancer: a publication bias? Br. Med. J. , 296 , 391 – 392 ( 1988. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37. ) Kobori , O. , Shimizu , T. , Maeda , M. , Atomi , Y. , Watanabe , L , Shoji , M. and Morioka , Y.Enhancing effect of bile and bile acid on stomach tumorigenesis induced by N‐methyl‐N ‐nitro‐N‐nitrosoguanidine in Wistar rats . J. Natl. Cancer Inst. , 73 , 853 – 861 ( 1984. ). [PubMed] [Google Scholar]
  • 38. ) Salmon , R. J. , Merle , S. , Zafrani , B. , Decosse , J. J. , Sherlock , P. and Deschner , E. E.Gastric carcinogenesis induced by N‐methyl‐N ‐nitro‐N‐nitrosoguanidine: role of gastrectomy and duodenal reflux . Jpn. J. Cancer Res. , 76 , 167 – 172 ( 1985. ). [PubMed] [Google Scholar]
  • 39. ) Oflferhaus , G. J. A. , Stadt , J. , Huibregtse , K. , Tersmette , A. C. and Tytgat , G. N. J.The mucosa of the gastric remnant harboring malignancy. Histological findings in the biopsies of 504 asymptomatic patients 15–46 years after partial gastrectomy with the emphasis on non‐malignant lesions . Cancer , 64 , 698 – 703 ( 1989. ). [DOI] [PubMed] [Google Scholar]
  • 40. ) Howson , C. P. , Hiyama , T. and Wynder , E. L.The decline in gastric cancer: epidemiology of an unplanned triumph . Epidemiol. Rev. , 8 , 1 – 27 ( 1986. ). [DOI] [PubMed] [Google Scholar]
  • 41. ) Haenszel , W. and Kurihara , M.Studies of Japanese migrants. I. Mortality from cancer and other diseases among Japanese in the United States . J. Natl. Cancer Inst. , 40 , 43 – 68 ( 1968. ). [PubMed] [Google Scholar]
  • 42. ) Fielding , J. W. L.Gastric cancer: different diseases . Br. J. Surg. , 76 , 1227 ( 1989. ). [DOI] [PubMed] [Google Scholar]
  • 43. ) Antonioli , D. A. and Goldman , H.Changes in the location and type of gastric adenocarcinoma . Cancer , 50 , 775 – 781 ( 1982. ). [DOI] [PubMed] [Google Scholar]
  • 44. ) Flamant , R. , Lasserre , O. , Lazar , P. , Leguerinais , J. , Denoix , P. , and Schwartz , D.Differences in sex ratio according to cancer site and possible relationship with use of tobacco and alcohol: review of 65,000 cases . J. Natl. Cancer Inst. , 32 , 1309 – 1316 ( 1964. ). [DOI] [PubMed] [Google Scholar]
  • 45. ) Orlando , R. and Welch , J. P.Carcinoma of the stomach after gastric operation . Am. J. Surg. , 141 , 487 – 491 ( 1981. ). [DOI] [PubMed] [Google Scholar]
  • 46. ) Offerhaus , G. J. A.Het carcinoom in de geopereerde maag. Een epidemiologisch, endoscopisch‐bioptisch en celkinetisch follow‐up onderzoek . Dissertation, University of Amsterdam, The Netherlands ( 1983. ).
  • 47. ) Itoh , H. , Oahata , Y. , Nakamura , K. , Nagata , T. , Mibu , R. and Nakayama , F.Complete ten‐year post‐gastrectomy follow‐up of early gastric cancer . Am. J. Surg. , 158 , 14 – 16 ( 1989. ). [DOI] [PubMed] [Google Scholar]
  • 48. ) Yoshimori , M.The natural history of early gastric cancer . Jpn. J. Clin. Oncol. , 19 , 89 – 93 ( 1989. ). [PubMed] [Google Scholar]

Articles from Japanese Journal of Cancer Research : Gann are provided here courtesy of Wiley

RESOURCES