title: Increased risk of laryngeal and pharyngeal cancer after gastrectomy for ulcer disease in a population-based cohort study.
abstract: BACKGROUND
  Gastrectomy has been indicated as a risk factor for laryngeal cancer, and possibly also for pharyngeal cancer, but few studies are available. The postulated mechanism is increased bile reflux following gastrectomy.
  
  
  METHODS
  This was a population-based cohort study of patients who underwent gastrectomy for peptic ulcer disease between 1964 and 2008 in Sweden. Follow-up data for cancer was obtained from the Swedish Cancer Register. Relative risk was calculated as standardised incidence ratios (SIRs) with 95% confidence intervals (CIs).
  
  
  RESULTS
  The gastrectomy cohort comprises 19 767 patients, contributing 348 231 person-years at risk. The observed number of patients with laryngeal (n=56) and pharyngeal cancer (n=28) was two-fold higher than the expected (SIR: 2.0, 95% CI: 1.5-2.6 and SIR: 2.4, 95% CI: 1.6-3.5, respectively). After exclusion of 5536 cohort members with tobacco- or alcohol-related disease, the point SIRs remained increased (SIR: 1.6, 95% CI: 1.1-2.2 and SIR: 1.7, 95% CI: 0.9-2.8, respectively). The SIRs of laryngeal and pharyngeal cancer increased with time after gastrectomy (P for trend <0.0001), and were particularly increased 30 years after gastrectomy (SIR: 4.8, 95% CI: 2.1-9.5 and SIR: 10.2, 95% CI: 3.7-22.3, respectively).
  
  
  CONCLUSIONS
  Gastrectomy for peptic ulcer disease might entail a long-term increased risk of laryngeal and pharyngeal cancer.
authors.affiliation: Department of Molecular Medicine and Surgery, Upper Gastrointestinal Research, Karolinska Institutet, Norra Stationsgatan 67, Level 2, 17176 Stockholm, Sweden. jesper.lagergren@ki.se
authors.forename: J
authors.initials: J
authors.lastname: Lagergren
authors.forename: A
authors.initials: A
authors.lastname: Lindam
mesh_terms: D015331:Cohort Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects; D006801:Humans; D007822:Laryngeal Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000601:surgery*; D010610:Pharyngeal Neoplasms / Q000453:epidemiology*; D018570:Risk Assessment; D013548:Sweden / Q000453:epidemiology