Malignant disease in peptic ulcer surgery patients after long term follow-up: a cohort study of 1992 patients.
OBJECTIVE
To assess the effect of previous peptic ulcer surgery on subsequent malignant events, in particular in relation to previous vagotomy, a historical cohort study was conducted.


METHODS
All patients undergoing surgery for peptic ulcer disease with accurate follow-up data at a large peptic ulcer clinic in the Western Infirmary, Glasgow, from 1965 to 1983 were assessed. All cancer events and specific cancer events (gastric, bronchial, laryngeal, colorectal, bladder, breast, prostate, pancreas, kidney, oesophageal cancers) were determined as outcome measures and expressed as standardised incidence ratio (SIR).


RESULTS
Vagotomy and drainage accounted for 67% of all procedures for peptic ulcer disease. Eighty-three percent were habitual smokers. For all peptic ulcer surgery patients, the SIR for all cancer events was 0.86. For specific cancers, the SIRs were bronchial cancer (SIR 1.13); laryngeal cancer (SIR 2.17), colorectal cancer (SIR 0.67). For vagotomised patients the risk of gastric cancer was significantly elevated (SIR 1.50).


CONCLUSIONS
An excess of cancers attributable to smoking have been found in peptic ulcer surgery patients. Vagotomised patients have a higher risk of gastric cancer after long term follow-up. This finding may have implications for screening and the safety of long term acid suppression with agents such as proton pump inhibitors.
Jenkins
J T
JT
Department of Surgery, Crosshouse Hospital, Kilmarnock, UK. mrianjenkins@hotmail.com
Duncan
J R
JR
Hole
D
D
O'Dwyer
P J
PJ
McGregor
J R
JR
D001984:Bronchial Neoplasms / Q000453:epidemiology; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000453:epidemiology; D004322:Drainage / Q000706:statistics & numerical data; D004381:Duodenal Ulcer / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005763:Gastroenterostomy / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007822:Laryngeal Neoplasms / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000453:epidemiology*; D010437:Peptic Ulcer / Q000601:surgery*; D012004:Rectal Neoplasms / Q000453:epidemiology; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000453:epidemiology; D014628:Vagotomy / Q000706:statistics & numerical data*