TY - JOUR
T1 - Meta-Analysis of the Risk of Gastric Stump Cancer
T2 - Detection of High Risk Patient Subsets for Stomach Cancer after Remote Partial Gastrectomy for Benign Conditions
AU - Tersmette, Anne C.
AU - Offerhaus, G. Johan A.
AU - Tersmette, Kasper W.F.
AU - Giardiello, Francis M.
AU - Moore, G. William
AU - Tytgat, Guido N.J.
AU - Vandenbroucke, Jan P.
PY - 1990/10/15
Y1 - 1990/10/15
N2 - Controversy about gastric cancer risk after partial gastrectomy exists, especially in the United States. Therefore, we performed a meta-analysis to determine overall relative risk and weighted mean relative risk for subsets of postgastrectomy patients, define possible high risk patients suitable for surveillance, and assess for publication bias which would overestimate risk. If 2 studies were excluded because of heterogeneity, overall relative risk (RR) for gastric stump cancer in 22 studies analyzed was 1.66 [95% confidence limits (CL), 1.54–1.79). With these 2 studies included, the RR summarized with a random effects model to account for study heterogeneity was 1.46 (95% CL, 1.18–1.82). No obvious evidence of publication bias was detected. Patients 15 years or more postoperative had a weighted mean RR of 1.48 (95% CL, 131–1.67) and patients 5–14 years postoperative had a RR of 0.91 (95% CL, 0.71–1.17) (P = 0.026). Patients operated upon for gastric ulcer had a weighted mean RR of 2.12 (95% CL, 1.73–2.59) and patients with duodenal ulcers had a RR of 0.84 (95% CL, 0.66–1.05) (P = 0.001). The weighted mean RR for females was 1.79 (95% CL, 139–2.29) and for males 1.43 (95% CL, 1.27–1.62) (P = 0.074). For Billroth II gastrectomy the weighted mean RR was 1.60 (95% CL, 1.15–2.18) and for Billroth I gastrectomy 1.20 (95% CL, 1.01–1.42) (P = 0.220). Although differences in risk between subsets of postgastrectomy patients seem to exist, recommendations concerning endoscopic surveillance await further studies of cost-benefit analysis.
AB - Controversy about gastric cancer risk after partial gastrectomy exists, especially in the United States. Therefore, we performed a meta-analysis to determine overall relative risk and weighted mean relative risk for subsets of postgastrectomy patients, define possible high risk patients suitable for surveillance, and assess for publication bias which would overestimate risk. If 2 studies were excluded because of heterogeneity, overall relative risk (RR) for gastric stump cancer in 22 studies analyzed was 1.66 [95% confidence limits (CL), 1.54–1.79). With these 2 studies included, the RR summarized with a random effects model to account for study heterogeneity was 1.46 (95% CL, 1.18–1.82). No obvious evidence of publication bias was detected. Patients 15 years or more postoperative had a weighted mean RR of 1.48 (95% CL, 131–1.67) and patients 5–14 years postoperative had a RR of 0.91 (95% CL, 0.71–1.17) (P = 0.026). Patients operated upon for gastric ulcer had a weighted mean RR of 2.12 (95% CL, 1.73–2.59) and patients with duodenal ulcers had a RR of 0.84 (95% CL, 0.66–1.05) (P = 0.001). The weighted mean RR for females was 1.79 (95% CL, 139–2.29) and for males 1.43 (95% CL, 1.27–1.62) (P = 0.074). For Billroth II gastrectomy the weighted mean RR was 1.60 (95% CL, 1.15–2.18) and for Billroth I gastrectomy 1.20 (95% CL, 1.01–1.42) (P = 0.220). Although differences in risk between subsets of postgastrectomy patients seem to exist, recommendations concerning endoscopic surveillance await further studies of cost-benefit analysis.
UR - http://www.scopus.com/inward/record.url?scp=0025049868&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0025049868&partnerID=8YFLogxK
M3 - Article
C2 - 2145061
AN - SCOPUS:0025049868
SN - 0008-5472
VL - 50
SP - 6486
EP - 6489
JO - Cancer Research
JF - Cancer Research
IS - 20
ER -