title: Association of laryngeal cancer with previous gastric resection.
abstract: 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.
authors.affiliation: Institute of Internal Medicine, Catholic University of Medicine and Surgery, Rome, Italy. gcammarota@rm.unicatt.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cammarota
authors.forename: Jacopo
authors.initials: J
authors.lastname: Galli
authors.forename: Rossella
authors.initials: R
authors.lastname: Cianci
authors.forename: Eugenio
authors.initials: E
authors.lastname: De Corso
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pasceri
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.forename: Giovanna
authors.initials: G
authors.lastname: Masala
authors.forename: Antonio
authors.initials: A
authors.lastname: Buffon
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Almadori
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paludetti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gasbarrini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Maurizi
mesh_terms: 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