Carcinogenesis after Remote Peptic Ulcer Surgery: The Long-term Prognosis of Partial Gastrectomy

Tersmette, A. C.; Giardiello, F. M.; Tytgat, G. N. J.; Offerhaus, G. J. A.

doi:10.3109/00365529509090306

Cited by 33 publications

(15 citation statements)

References 39 publications

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“…Schafer et al 66 concluded that there was no increased risk of developing gastric cancer after subtotal gastrectomy. In contrast, Tersmette et al 73 concluded that there was up to a four-fold to five-fold increase in risk after the operation.…”

Section: Discussionmentioning

confidence: 92%

Gastric Stromal Tumors in Carney Triad Are Different Clinically, Pathologically, and Behaviorally From Sporadic Gastric Gastrointestinal Stromal Tumors: Findings in 104 Cases

Zhang¹,

Smyrk²,

Young

et al. 2010

American Journal of Surgical Pathology

206

185

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Carney triad, as originally described in 1977, was the association of 3 tumors: gastric epithelioid leiomyosarcoma [later renamed gastrointestinal stromal tumor (GIST)], extra-adrenal paraganglioma, and pulmonary chondroma. The disorder affected mostly young women and was not familial. We studied the clinical and pathologic features of the gastric neoplasm in 104 patients with the syndrome. Most (88%) were young women (mean age, 22 y), and the usual presentation was gastric bleeding. The tumors, commonly antral-based (61%), were multifocal, and ranged from 0.2 to 18.0 cm in dimension. Most (86%) featured round and polygonal (epithelioid) cells. Metastasis occurred in 49 patients (47%): to gastric lymph nodes (29%), liver (25%), and peritoneum (13%). Immunopositivity was detected in the tumors tested as follows: KIT, 100%; CD34, 75%; PKCy, 21%; PDGFRA, 90%; and smooth muscle actin, 6%. Fourteen patients (13%) died of metastatic GIST at a mean age of 45 years (range, 30 to 69 y). Estimated 10 and 40-year survivals were 100% and 73%, respectively. Median survival time was 26.5 years (range, 16 to 60 y). There was no correlation between the National Institutes of Health tumor risk classification and the tumor behavior. Compared with sporadic gastric GISTs, the gastric stromal tumor in Carney triad showed distinctive features: female predilection, young patient age, epithelioid cell predominance, multifocality, frequent lymph node metastasis, serial tumor occurrence, and unpredictable behavior. Thus, the Carney triad gastric stromal tumor is different clinically, pathologically, and behaviorally from sporadic gastric GIST.

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Section: Discussionmentioning

confidence: 92%

Gastric Stromal Tumors in Carney Triad Are Different Clinically, Pathologically, and Behaviorally From Sporadic Gastric Gastrointestinal Stromal Tumors: Findings in 104 Cases

Zhang¹,

Smyrk²,

Young

et al. 2010

American Journal of Surgical Pathology

206

185

View full text Add to dashboard Cite

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“…Some studies showed an elevated risk of pancreatic cancer among patients with duodenal ulcer, or with ulcers in general,11, 12, 13, 14 while some failed to confirm this association 3, 15, 16, 17. Studies among patients with a history of partial gastric resection have likewise yielded mixed results, some supporting a link to pancreatic cancer3, 14, 18, 19, 20, 21, 22, 23 and others refuting it 15, 24, 25…”

mentioning

confidence: 99%

The risk of pancreatic cancer in patients with gastric or duodenal ulcer disease

Luo

Nordenvall

Nyrén

et al. 2006

Intl Journal of Cancer

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Although Helicobacter pylori (H. pylori) seropositivity is linked to an excess risk of pancreatic cancer, the biologic mechanism is unknown. Gastric ulcer is primarily associated with corpus colonization of H. pylori, atrophic gastritis and formation of N-nitrosamines. Duodenal ulcer is a marker of antral colonization, hyperacidity and uninhibited secretin release. We estimated relative risks for pancreatic cancer among patients with gastric or duodenal ulcer, based on a register-based retrospective cohort study with 88,338 patients hospitalized for gastric ulcer and 70,516 patients for duodenal ulcer recorded in the Swedish Inpatient Register between 1965 and 2003. Following operation, the 14,887 patients who underwent gastric resection and 8,205 with vagotomy were analyzed separately. Multiple record-linkages allowed complete follow-up and identification of all incident cases of pancreatic cancer until December 31, 2003. Standardized incidence ratios (SIRs) estimated relative risks. During years 3-38 of follow-up, we observed a 20% excess risk (95% confidence interval [CI] 10-40%) for pancreatic cancer among unoperated gastric ulcer patients. The excess increased to 50% (95% CI 10-110%) 15 years after first hospitalization (p for trend 5 0.03). SIR was 2.1 (95% CI 1.4-3.1) 20 years after gastric resection. Unoperated duodenal ulcer was not associated with pancreatic cancer risk, nor was vagotomy. Our results lend indirect support to the nitrosamine hypothesis, but not to the hyperacidity hypothesis in the etiology of pancreatic cancer. ' 2006 Wiley-Liss, Inc.Key words: pancreatic cancer; gastric ulcer; duodenal ulcer; gastrectomy; vagotomy; risk; cohort Pancreatic cancer is the most deadly neoplasm in humans.1 Little is known about its etiology apart from known relationships with smoking, a family history, and some rare genetic susceptibility syndromes. Alleged causal links with diabetes and nonhereditary chronic pancreatitis remain under debate.2 Possible association between a history of gastroduodenal diseases and pancreatic cancer was first suggested by an early case-control study, 3 in which a strong association between subtotal gastrectomy and pancreatic cancer was reported. The authors postulated that one of the possible mechanisms is via increased Nnitroso compounds in gastric juice after the operation. Recently, a moderately strong association with Helicobacter pylori (H. pylori) infection was reported. 4,5 Although confounding from unknown causal factors cannot be ruled out as an explanation, there are at least three hypothetical models for the influence of H. pylori on pancreatic carcinogenesis. Firstly, bacterial invasion of the organ and local chronic inflammation, is conceivable but there are no reports in the literature of H. pylori growth in pancreatic tissue or ducts. The second, more plausible, hypothesis involves predominantly gastric antral colonization, hyperchlorhydria, uninhibited secretin release, attendant elevations in basal pancreatic bicarbonate output and pancreatic ductular hyperp...

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“…The risk begins to increase even 10 to 15 years after the initial operation. 1 Because the EGD did not reveal a bezoar in our patient, it is the least likely cause of the ulcer. It is easily identified on EGD and consists of concretions of foreign material (hair, vegetable fiber, medications) that either cause no symptoms or lead to a variety of complaints: early satiety, anorexia, nausea, vomiting, or bloating.…”

Section: Which One Of the Following Is The Least Likely Cause Of Recumentioning

confidence: 95%

68-Year-Old Man With Peptic Ulcer and Diarrhea

Ribeiro

Cangemi

1997

Mayo Clinic Proceedings

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Carcinogenesis after Remote Peptic Ulcer Surgery: The Long-term Prognosis of Partial Gastrectomy

Cited by 33 publications

References 39 publications

Gastric Stromal Tumors in Carney Triad Are Different Clinically, Pathologically, and Behaviorally From Sporadic Gastric Gastrointestinal Stromal Tumors: Findings in 104 Cases

Gastric Stromal Tumors in Carney Triad Are Different Clinically, Pathologically, and Behaviorally From Sporadic Gastric Gastrointestinal Stromal Tumors: Findings in 104 Cases

The risk of pancreatic cancer in patients with gastric or duodenal ulcer disease

68-Year-Old Man With Peptic Ulcer and Diarrhea

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