An investigation of possible risk factors associated with gastric cancer after benign ulcer operations.
The risk of developing gastric cancer has been investigated in a case-control study and in a prospective investigation. In the case-control study, 1495 cases of gastric cancer were identified in five city hospitals and matched with autopsy controls from the same hospitals. The frequency of operations for benign ulcer [partial gastrectomy (PG) and gastroenterostomy] was similar in the two groups. Thus, there was no increased risk for late gastric cancer after an ulcer operation. A total of 140 operated ulcer subjects [80 truncal vagotomy and drainage (TVD), 60 PG and 78 nonoperated cases attending with dyspepsia (C)] were examined by endoscopy, multiple gastric biopsy and analysis of gastric juice for nitrite. Biopsies were graded for gastritis and a gastritis index was derived (normal, 1; superficial gastritis, 2; chronic atrophic gastritis: mild, 3; moderate, 4; severe, 5). More atrophic gastritis was found in operated subjects than in controls: TVD, 2.3 +/- 0.08 (mean +/- SE); PG, 2.6 +/- 0.1 versus C, 1.8 +/- 0.08, p less than 0.01. The severity of atrophic gastritis increased after an operation interval of 20 years in PG subjects (p less than 0.05). Intestinal metaplasia was a common change, but unequivocal epithelial dysplasia was not observed. Two cases of operated stomach cancer were found. High levels of nitrite were positively correlated with pH and a high gastritis index. This evidence does not suggest that ulcer surgery leads to either an increased risk of cancer or a precancerous condition.
Ware
J
J
Department of Surgery, University of Liverpool, Royal Liverpool Hospital, UK.
Corcoran
G D
GD
Day
D W
DW
O'Donnell
C M
CM
Newton
C J
CJ
Taylor
W H
WH
D005743:Gastrectomy; D005756:Gastritis / Q000473:pathology; D006801:Humans; D011183:Postoperative Complications; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000209:etiology*; D013276:Stomach Ulcer / Q000150:complications / Q000601:surgery*; D014628:Vagotomy