Association of laryngeal cancer with previous gastric resection.
OBJECTIVE
To investigate the association between gastric surgery and cancer of the larynx.


BACKGROUND
Biliary reflux is frequent after gastric surgery and may reach the proximal segment of the esophagus and the larynx. It is possible that duodenal content (consisting in bile acids, trypsin), together with pepsin and acid residues when gastric resection is partial, may cause harmful action on the multistratified epithelium of the larynx.


METHODS
A retrospective case-control study on subjects admitted between January 1987 and May 2002 in the same hospital in Rome was carried out. The study included 828 consecutive patients with laryngeal cancer (cases) and 825 controls with acute myocardial infarction. Controls were randomly sampled out of a total of 10,000 and matched with cases for age, sex, and year of admission. Logistic regression models were used to assess the role of gastric resection in determining laryngeal cancer risk while controlling for potential confounding factors.


RESULTS
Previous gastrectomy was reported by 8.1% of cases and 1.8% of the controls (P < 0.0001). A 4-fold association emerged between gastric surgery and laryngeal cancer risk (adjusted OR = 4.3, 95% CI: 2.4-7.9). The risk appeared strongly increased 20 years after surgery (OR = 14.8, 95% CI: 3.4-64.6). Heavy alcohol drinking (OR = 2.5, 95% CI: 1.8-3.5), smoking (OR = 4.7, 95% CI: 3.3-6.7), and blue-collar occupation (OR = 4.6, 95% CI: 3.2-6.7) were all independently associated with the risk of laryngeal cancer.


CONCLUSIONS
Previous gastric surgery is associated with an increased risk of laryngeal cancer. A periodic laryngeal examination should be considered in long-term follow-up of patients with gastric resection.
Cammarota
Giovanni
G
Institute of Internal Medicine, Catholic University of Medicine and Surgery, Rome, Italy. gcammarota@rm.unicatt.it
Galli
Jacopo
J
Cianci
Rossella
R
De Corso
Eugenio
E
Pasceri
Vincenzo
V
Palli
Domenico
D
Masala
Giovanna
G
Buffon
Antonio
A
Gasbarrini
Antonio
A
Almadori
Giovanni
G
Paludetti
Gaetano
G
Gasbarrini
Giovanni
G
Maurizi
Maurizio
M
D000368:Aged; D000428:Alcohol Drinking; D002294:Carcinoma, Squamous Cell / Q000209:etiology* / Q000473:pathology; D018289:Carcinoma, Verrucous / Q000209:etiology / Q000473:pathology; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009790:Occupations; D012307:Risk Factors; D012907:Smoking