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
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.