Stomach Cancer after Partial Gastrectomy for Benign Ulcer Disease

Abstract

We followed for 25 to 33 years 6459 patients who had undergone partial gastrectomy for benign ulcer disease to determine the incidence of stomach cancer. The overall risk was no different from that among sex- and age-matched controls from the Swedish Cancer Registry (standardized incidence ratio = 0.96; 95 percent confidence limits, 0.78 and 1.16). However, when the patients were classified according to the duration of follow-up after operation, sex, surgical procedure, diagnosis at the time of operation, and age at operation, differences in risk were observed between the subgroups. After adjustment for potential confounding variables, the average adjusted risk increased 28 percent (adjusted standardized incidence ratio = 1.28; 95 percent confidence limits, 1.11 and 1.49) for each successive five-year interval after operation. The adjusted risk was greater among women than men (adjusted standardized incidence ratio = 1.96; 95 percent confidence limits, 1.18 and 3.24). Patients who had undergone a Billroth I anastomosis had a lower crude risk, both overall (standardized incidence ratio = 0.40; 95 percent confidence limits, 0.20 and 0.71) and after we controlled for other confounding variables (adjusted standardized incidence ratio = 0.27; 95 percent confidence limits, 0.12 and 0.62), than did those who had undergone a Billroth II procedure. The adjusted risk of stomach cancer was greater among patients operated on for gastric ulcer than among those operated on for duodenal ulcer (adjusted standardized incidence ratio = 2.21; 95 percent confidence limits, 1.45 and 3.35). Risk decreased with increased age at operation. Between successive strata of age at operation (less than 39, 40 to 49, 50 to 59, and greater than or equal to 60 years of age), the adjusted risk decreased on the average by about half (adjusted standardized incidence ratio = 0.52; 95 percent confidence limits, 0.41 and 0.66).

Risk of Stomach Cancer in Patients with Peptic Ulcer Disease

“…During the past decade a number of well designed, large, retrospective, cohort studies were conducted with almost complete follow-up extending 30 years or more after gastric surgery [65][66][67][68][69][70][71][72][73]. In summary, these studies have revealed the following: (1) Patients treated with partial distal gastrectomy for duodenal ulcer have a low RR (approximately 0.6) of gastric cancer during the first 20 years after surgery [65,66,69,71,72].…”

Laparoscopic completion total gastrectomy for remnant gastric cancer: a single-institution experience

“…Remnant gastric cancer is defined as gastric cancer in the remnant stomach after partial gastrectomy for benign disease or gastric cancer [2]. The rate of remnant gastric cancer is higher after a Billroth II procedure than a Billroth I procedure, and remnant gastric cancer is caused by the continuous bathing of the gastric remnant with bile acids, resulting in repeated mucosal inflammation and regeneration [3][4][5][6][7]. Completion total gastrectomy with radical lymphadenectomy is the only potentially curable option for remnant gastric cancer.…”

Risk factors for complications during surgical treatment of remnant gastric cancer

“…Gastric resection for a benign ulcer was frequently performed two or three decades earlier when physicians did not commonly use H 2 -receptor antagonists or proton pump inhibitors. However, the risk of remnant gastric cancer is linked to the length of time that has passed since the gastrectomy was performed [7,8]. Therefore, we can anticipate an increasing occurrence of remnant gastric cancer in patients who have undergone a gastrectomy for any reason.…”