CARCINOGENESIS AFTER REMOTE PEPTIC-ULCER SURGERY - THE LONG-TERM PROGNOSIS OF PARTIAL GASTRECTOMY

Citation
Ac. Tersmette et al., CARCINOGENESIS AFTER REMOTE PEPTIC-ULCER SURGERY - THE LONG-TERM PROGNOSIS OF PARTIAL GASTRECTOMY, Scandinavian journal of gastroenterology, 30, 1995, pp. 96-99
Citations number
49
Categorie Soggetti
Gastroenterology & Hepatology
ISSN journal
00365521
Volume
30
Year of publication
1995
Supplement
212
Pages
96 - 99
Database
ISI
SICI code
0036-5521(1995)30:<96:CARPS->2.0.ZU;2-B
Abstract
Remote partial gastrectomy for benign disease is a premalignant condit ion. The overall risk of gastric stump cancer is approximately a twofo ld increase, but patients more than 20-25 years postoperatively may ha ve a four- to fivefold increased risk, compared to the age- and sex-ma tched general population. The duration of postoperative interval is th e most important risk factor. For the first 10 years after initial sur gery, gastric cancer risk may be reduced due to the removal of the mos t cancer-prone distal part of the stomach, but thereafter there is a r apid increase of the relative risk. The etiology and precise mechanism of carcinogenesis is unknown, but the time relationship with surgery suggests that the anatomical alterations induced by the operation must be important. Hypochlorhydria, reflux, diminished gastrin production, bacterial proliferation, and nitrosation are the putative contributin g factors. In addition, smoking appears to contribute to a generalized cancer mortality and decreased life expectancy after peptic ulcer sur gery. Digestive tract cancers other than the gastric ones which show a n increased risk after peptic ulcer surgery are pancreatic and biliary tract cancers. Premalignant and precursor lesions occur more frequent ly in the gastric remnant after peptic ulcer surgery and endoscopic bi optic screening can detect early stump cancers at a curable stage. Lar ge-scale screening programs of post-gastrectomy patients are neverthel ess not recommended, and surveillance appears not justified.