Kinetic changes and experimental carcinogenesis after Billroth I and II gastrectomy.
To determine the risk of gastric remnant cancer according to the type of surgical reconstruction, the distal two-thirds of the glandular stomach was resected in male Wistar rats, followed by gastroduodenostomy (Billroth I anastomosis) or gastrojejunostomy (Billroth II anastomosis). No carcinogens were given and the animals were killed 50 weeks after operation. No cancers developed in 22 rats undergoing Billroth I gastrectomy, but five of 24 with Billroth II anastomosis had adenocarcinoma (P < 0.05). All carcinomas were confined to the stoma. Animals with Billroth II anastomosis had a more advanced grade of mucosal atrophy at the stoma, with a higher incidence of cystic dilatation, submucosal adenocystic proliferation and pseudopyloric metaplasia (P < 0.05). Cell kinetics in the stomal mucosa after Billroth II gastrectomy showed an increased cell count in the proliferative zone, longer duration of S phase and increased cell cycle time (P < 0.05). These results suggest that Billroth II gastrectomy carries a greater risk of cancer than the Billroth I procedure.
Miwa
K
K
Department of Surgery II, Kanazawa University, Japan.
Kamata
T
T
Miyazaki
I
I
Hattori
T
T
D000714:Anastomosis, Surgical / Q000009:adverse effects; D000818:Animals; D002455:Cell Division; D004386:Duodenum / Q000601:surgery; D005743:Gastrectomy / Q000009:adverse effects*; D005755:Gastrins / Q000097:blood; D007583:Jejunum / Q000601:surgery; D008297:Male; D051381:Rats; D017208:Rats, Wistar; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000209:etiology* / Q000473:pathology
D005755:Gastrins