DEATH FROM MALIGNANT DISEASE AFTER SURGERY FOR DUODENAL-ULCER

A total of 2241 patients who had an operation for duodenal ulcer betwe en 1947 and 1968 were followed up to determine the cause of death and to compare the observed number of deaths with the expected. Death cert ificates were traced for 1251 of 1387 known to have died. Observed dea ths from all causes were significantly greater than expected (O/E 1.13 ) (95% CI 1.08 to 1.20). This was because of significant increases in deaths from neoplasms (O/E 1.25) (95% CI 1.13 to 1.39) and digestive d iseases (O/E 1.71) (95% CI 1.11 to 2.59). Analysis of deaths from mali gnant disease showed an excess of deaths from carcinoma of lung (O/E 1 .37) (95% CI 1.14 to 1.62) and from smoking related cancers (O/E 1.32) (95% CI 1.13 to 1.52) but there was no significant excess mortality fr om any other neoplasm. An excess of deaths within one year of the oper ation was seen from circulatory disease (O/E 1-85) (95% CI 1.17 to 2-7 8), respiratory disease (O/E 3.56) (95% CI 1.78 to 6.37), and digestiv e disease (O/E 21.46) (95% CI 13.75 to 31.93). These deaths are concen trated in the first postoperative month and as there is no excess mort ality from circulatory, respiratory or digestive disease between 1 and 20 years postoperatively, show the direct effects of the operation as a cause of death. This together with the excess mortality from all re spiratory disease confirms that excess mortality after duodenal ulcer surgery is, in the short term, the result of the operation itself and in the long term largely attributable to cigarette smoking. Operations for gastric ulcer largely account for the subsequent excess mortality from gastric cancer reported after peptic ulcer surgery. The findings do not support the theory that the operation has carcinogenic effects and do not support the case for routine endoscopic screening after op erations for duodenal ulcer.