TY - JOUR
T1 - Carcinogenesis after remote peptic ulcer surgery
T2 - The long-term prognosis of partial gastrectomy
AU - Tersmette, A. C.
AU - Giardiello, F. M.
AU - Tytgat, G. N.J.
AU - Offerhaus, G. J.A.
PY - 1995
Y1 - 1995
N2 - Remote partial gastrectomy for benign disease is a premalignant condition. The overall risk of gastric stump cancer is approximately a twofold increase, but patients more than 20-25 years postoperatively may have a four- to fivefold increased risk, compared to the age- and sex-matched general population. The duration of postoperative interval is the most important risk factor. For the first 10 years after initial surgery, gastric cancer risk may be reduced due to the removal of the most cancer-prone distal part of the stomach, but thereafter there is a rapid 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 contributing factors. In addition, smoking appears to contribute to a generalized cancer mortality and decreased life expectancy after peptic ulcer surgery. Digestive tract cancers other than the gastric ones which show an increased risk after peptic ulcer surgery are pancreatic and biliary tract cancers. Premalignant and precursor lesions occur more frequently in the gastric remnant after peptic ulcer surgery and endoscopic bioptic screening can detect early stump cancers at a curable stage. Large-scale screening programs of post-gastrectomy patients are nevertheless not recommended, and surveillance appears not justified.
AB - Remote partial gastrectomy for benign disease is a premalignant condition. The overall risk of gastric stump cancer is approximately a twofold increase, but patients more than 20-25 years postoperatively may have a four- to fivefold increased risk, compared to the age- and sex-matched general population. The duration of postoperative interval is the most important risk factor. For the first 10 years after initial surgery, gastric cancer risk may be reduced due to the removal of the most cancer-prone distal part of the stomach, but thereafter there is a rapid 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 contributing factors. In addition, smoking appears to contribute to a generalized cancer mortality and decreased life expectancy after peptic ulcer surgery. Digestive tract cancers other than the gastric ones which show an increased risk after peptic ulcer surgery are pancreatic and biliary tract cancers. Premalignant and precursor lesions occur more frequently in the gastric remnant after peptic ulcer surgery and endoscopic bioptic screening can detect early stump cancers at a curable stage. Large-scale screening programs of post-gastrectomy patients are nevertheless not recommended, and surveillance appears not justified.
KW - Carcinogenesis
KW - Gastric stump cancer
KW - Partial gastrectomy
KW - Precursor lesions
KW - Surveillance
UR - http://www.scopus.com/inward/record.url?scp=0029442010&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0029442010&partnerID=8YFLogxK
U2 - 10.3109/00365529509090306
DO - 10.3109/00365529509090306
M3 - Article
C2 - 8578237
AN - SCOPUS:0029442010
SN - 0036-5521
VL - 30
SP - 96
EP - 99
JO - Scandinavian Journal of Gastroenterology
JF - Scandinavian Journal of Gastroenterology
IS - S212
ER -