Gastric carcinoma after surgical treatment of peptic ulcer - An analysis of morphologic features and a comparison with cancer in the nonoperated stomach

BACKGROUND. Surgery for peptic ulcer is associated with an increased risk o f later development of gastric carcinoma. This risk applies to cancer occur ring in the distal stomach, not at the cardia. Mucosal alterations occurrin g in the nonneoplastic mucosa, adjacent to postgastrectomy carcinomas, are currently poorly defined. METHODS. Between 1975 and 1995, the authors collected records of 76 patient s with gastric carcinoma developing after previous ulcer surgery. Thirty-th ree gastrectomy specimens were available for study and were compared with a control series of gastric carcinomas occurring in the intact stomach. Morp hologic features studied were macroscopic findings, tumor type, extent of i nflammation, atrophy, intestinal metaplasia, reactive gastropathy, and pres ence of Helicobacter pylori. When possible, a semiquantitative grading syst em (Sydney system) was used. RESULTS. The 33 patients with resected carcinoma after ulcer surgery were r epresentative of the total 76 patients. There were no differences between t he seven postulcer surgery cardia carcinomas and the control cardia carcino mas. The 18 distal carcinomas occurring after prior gastrectomy had signifi cantly less intestinal metaplasia and Helicobacter pylori in the nonneoplas tic mucose than did the controls. Eight distal carcinomas occurring after a vagotomy and pyloroplasty had adjacent mucosa with findings intermediate b etween the gastrectomy carcinomas and the controls. CONCLUSIONS. The differences shown suggest that for distally located postga strectomy carcinomas Helicobacter pylori infection with extensive intestina l metaplasia may be relatively less important in pathogenesis and that inte stinal reflux with reactive gastropathy more important. There was no eviden ce to support a different mechanism of pathogenesis for postsurgical carcin omas occurring at the cardia from that of control cardia carcinomas. (C) 20 01 American Cancer Society.