Cancer Development in the Gastric Stump after Partial Gastrectomy for Ulcer^;

Helsingen, N; Hillestad, Leif

doi:10.1097/00000658-195614320-00003

Cited by 167 publications

(34 citation statements)

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“…In none could the lesions be regarded as true 'ulcer-cancers'. Helsingen and Hillestad (1956) found a greatly increased incidence of gastric carcinomas developing in patients who had earlier undergone partial gastrectomy for a benign gastric ulcer but not in patients operated on for duodenal ulcer. These findings suggest that stomachs liable to develop a gastric ulcer are also liable to develop a carcinoma, a view also taken by Swynnerton and Tanner (1953).…”

Section: Discussionmentioning

confidence: 91%

Surface carcinoma of the stomach

Mason¹

1965

Gut

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EDITORIAL SYNOPSIS Surface carcinomata confined to the mucosa have been found in 10% of stomachs operated on for apparently benign conditions. A multifocal origin is not uncommon. The prognosis is good. In this series the diagnosis was established by pathological studies on resected specimens but an increased awareness of this possibility may alert clinicians to make the diagnosis before operation.The majority of patients who present with a gastric carcinoma have a large growth which can be diagnosed with comparative ease, both by clinical procedures and by naked-eye inspection of the excised stomach. There is, however, a group of cases in which the growth is confined to the mucosa and, in the absence of an obvious tumour, the diagnosis can only be made by microscopic examination. The lesions have been studied by several authors (Ewing, 1936;Gutmann, Bertrand, and Peristiany, 1939;Mallory, 1940;Stout, 1942;Bamforth, 1955;Friesen, Dockerty, and ReMine, 1962) who have applied a variety of names but the most satisfactory term is probably 'superficial' or 'surface' carcinoma. Their particular importance lies both in the good prognosis and also in the information they provide on the pathogenesis of gastric cancer. The following series of cases is presented to show the incidence and pathological features of the condition. MATERIALS AND METHODSA total of 158 stomachs surgically removed by partial gastrectomy for apparently benign conditions were obtained fresh, opened along the greater curvature and pinned out flat on a cork board. Cytological studies were undertaken on the unfixed mucosa by scraping it in various areas with a toothbrush and spreading the material obtained onto a slide. Care was always taken to obtain a smear from the vicinity of any ulcer. The smears were fixed while still wet in Schaudinn's solution and stained with haemalum and eosin. The stomachs were then fixed on the cork board for 24 hours in formol saline. The entire lesser curvature was then sectioned using the 'swiss roll' technique of Magnus (1937), and stained with haematoxylin and eosin. Sections were also taken from any ulcers situated away from the lesser 'Present address: Department of Pathology, St. James's Hospital, Leeds. curve and from representative areas of the pyloric and body mucosa. Eight surface carcinomas were discovered by this means. When one of these lesions was found, it was mapped out and its size determined by taking further sections in a plane at right angles to the lesser curve as shown in Fig. 1, which illustrates the findings in case 1. A search was also made along the greater and lesser curvatures in all specimens for lymph nodes and sections taken of all those found.An additional four stomachs with surface carcinomas became available later and were examined in a similar way. Finally, a search through earlier gastrectomy specimens revealed three more stomachs in which surface carcinomas were present but these were not available for further sectioning.

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Section: Discussionmentioning

confidence: 91%

Surface carcinoma of the stomach

Mason¹

1965

Gut

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“…The average interval between gastroenterostomy and the recognition of gastric cancer in their series was 17 years and in their personal cases the interval was from 26 to 40 years. Helsingen and Hillestad (1956) were able to obtain information about 229 patients who had had a partial gastrectomy for simple peptic ulcer from 10 to 35 years before: 11 cases of cancer of the gastric stump occurred at an interval of 20 years and 10 of these followed resection for gastric ulcer and only one for duodenal ulcer. They comment that the observed rate of carcinoma in gastric ulcer patients is about three times the expected rate and that in duodenal ulcer patients it is approximately the normal rate.…”

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confidence: 99%

Gastric cancer associated with gastroenterostomy and partial gastrectomy.

Pygott¹

1968

Gut

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Gastric surgery as a definitive method of treatment for simple peptic ulcer has been practised on an increasing scale over the last 50 or 60 years. Despite operation complete relief may not result and the patient may present at widely varying periods afterwards with new or recurrent symptoms. Increasing age brings an increased risk of gastric cancer but the onset of this occasional sequel may be obscured by symptoms which may have followed more immediately after operation. The purpose of this paper is to describe our experiences in the radiological diagnosis of gastric cancer in 13 patients who had already had gastric surgery for simple peptic ulceration, eight having had a gastroenterostomy and five a partial gastrectomy.Records of individual cases of gastric cancer following gastroenterostomy appear in the literature from the mid 1920s onwards. Beatson gastric or duodenal ulcer. Eleven cases of gastric cancer were encountered among the patients previously operated on for duodenal ulcer, an average of 15 years after the gastroenterostomy. There were six cases of gastric cancer among those operated upon for gastric ulcer but five of the gastric ulcer cases were operated upon within two years of gastroenterostomy so it may be that the original diagnosis of simplicity was incorrect. Freedman and Berne (1954) record a collected series of 55 patients with gastric carcinoma of the gastroduodenal stoma and added a further three of their own. In their series 24 primary operations were for duodenal ulcer and 14 were for gastric ulcer, the reason being unknown in the remainder. The average interval between gastroenterostomy and the recognition of gastric cancer in their series was 17 years and in their personal cases the interval was from 26 to 40 years. Helsingen and Hillestad (1956) were able to obtain information about 229 patients who had had a partial gastrectomy for simple peptic ulcer from 10 to 35 years before: 11 cases of cancer of the gastric stump occurred at an interval of 20 years and 10 of these followed resection for gastric ulcer and only one for duodenal ulcer. They comment that the observed rate of carcinoma in gastric ulcer patients is about three times the expected rate and that in duodenal ulcer patients it is approximately the normal rate. De Jode (1961) reported 19 cases of gastric cancer following gastric operations, 12 following gastroenterostomy and seven partial gastrectomy in the 10 years 1949-58 at The London Hospital. Nine of his 12 gastroenterostomies were for duodenal ulcer and so were four of the seven partial gastrectomies; the remaining operations were for gastric ulcer. The interval between operation and gastric cancer was from 18 to 37 years in cases of gastroenterostomy and from two to 36 years after partial gastrectomy. In two cases occurring less than five years following the latter operation one patient had originally a duodenal ulcer and the other a gastric ulcer but in both the carcinoma was at the cardia and remote from the orig-117

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“…Severe atrophic gastritis is usually found in stomachs removed for benign gastric ulcer and Mason (1965) has found surface carcinoma in 10% of 78 partial gastrectomy specimens removed for benign gastric ulcer. Helsingen and Hillestad (1956) found an increased incidence of gastric carcinoma in patients who had had a standard partial gastrectomy for benign gastric ulcer, but not in patients operated on for duodenal ulcer. However, if the gastric mucosa in duodenal ulcer patients undergoes a similar atrophic process to that of the gastric ulcer patients this freedom from gastric cancer may not be absolute, and an operation which produces complete achlorhydria might conceivably predispose to the development of cancer of the stomach.…”

Section: Discussionmentioning

confidence: 85%