Remote partial gastrectomy as a risk factor for pancreatic cancer: Potential for preventive strategies

Background: Pancreatic cancer is the fifth leading cause of cancer death ma inly because of an advanced disease stage at the time of diagnosis. Patient s with a remote partial gastrectomy for benign ulcer disease may constitute a high risk group for pancreatic cancer; an increased index of suspicion c ould potentially lead to early detection in these patients. Methods: The risk of developing pancreatic cancer following partial gastrec tomy was evaluated by reviewing the literature. Furthermore, the risk of pa ncreatic cancer in an Amsterdam cohort of 2633 postgastrectomy patients has recently been assessed. The presence and type of K-ras codon 12 mutations in 15 postgastrectomy pancreatic cancer cases were also determined and comp ared to the conventional spectrum of these mutations in sporadic pancreatic cancer. Results: After a follow-up time of 20 years or mote since peptic ulcer surg ery, the relative risk reported in the literature varies from 1.65 to 5-fol d. In the Amsterdam cohere of 2633 postgastrectomy patients an overall incr eased risk of 1.8 was observed. The risk gradually increases to 3.6 after a postoperative interval of 35 years or more. A comparable frequency and typ e of K-ras codon 12 mutations was found in the postgastrectomy pancreatic c ancer cases as reported in sporadic pancreatic cancer in non-operated patie nts, suggesting a similar carcinogenesis in the two groups and indicating a potential utility of this molecular marker for surveillance strategies. Conclusions: Patients who underwent peptic ulcer surgery are at higher risk of developing subsequent pancreatic cancer, especially after a prolonged ( > 20 yrs) postoperative interval. An increased index of suspicion may contr ibute to early detection in these patients. The similar K-ras codon 12 muta tion pattern in conventional and postgastrectomy pancreatic cancers makes t his a suitable target for molecular diagnosis in these patients.