Das Krebsrisiko im Resektionsmagen

Abstract

The purpose of this study was to find whether the reflux of bile and pancreatic juices following stomach resection (duodenogastric reflux) enhances the incidence of carcinomas near the gastroenteric anastomosis. 72 male Wistar rats were subjected to stomach resection. The gastroenteric anastomosis (GE) was performed either as short loop anastomosis (Billroth II; n = 39), thus providing a continuous duodenogastric reflux, or as Y-shaped GE (according to Roux; n = 33). By the latter technique, bile and pancreatic juices are derived quantitatively into the jejunum without coming into contact with the remaining part of the stomach. During a period of 33 weeks, operated rats as well as intact animals were given the carcinogen N-methyl-N'-nitro-N-nitrosoguanidine (NG; 120 mg/l) in the drinking water. At autopsy, 33 to 36 weeks after daily oral administration of NG, most of the tumours were found in operated rats undergoing continuous reflux (Billroth II group). In contrast to these findings, the incidence or carcinomas was significantly lower in animals without reflex (Roux group or intact control rats).-The results of our experiments demonstrate that, in rats, the duodenogastric reflux contributes substantially to the development of carcinomas of the resected stomach.

Operation‐sequel carcinoma of the stomach. Experimental studies of surgical techniques with or without resection

“…The teams using surgical resection also obtained dissimilar results in spite of their apparently similar experimental conditions, probably due to the differing surgical techniques. These authors emphasized the importance of duodenogastric reflux as an etiopathogenetic factor [5][6][7]. However, an assay that compares not more than 3 groups with insufficient variations of reflux intensity appears inadequate to prove a direct correlation of duodenogastric reflux with carcinoma incidence or frequency.…”

Mechanism of action of diet as a carcinogen

“…The exception to this statement might be the fact that patients who have undergone surgery for gastric ulcers by a Billroth 1 or 2 procedure have a higher risk for gastric cancer, with a postulated involvement of bile acid reflux as a promoter. 12 .P rovided that the concepts presented are correct, the risk for gastric cancer can be reduced by assuring that appropriate amounts of food containing vitamin C are eaten with each meal on a year-round basis and that salt acting as an adjuvant be reduced. This action will have no potentiating effect whatsoever on colon, breast, and prostate cancer, and in fact, may also be beneficial.…”

Proline is not useful as a chemical probe to measure nitrosation in the gastrointestinal tract of patients with gastric disorders characterised by anacidic conditions.

“…Gastrointestinal disorders like CAG, BI and BIT status being characterised by achlorhydric gastric fluid and bacterial growth in the stomach have been identified as precursor lesions for gastric cancer. [22][23][24][25][26][27][28][29] The present investigation wanted to ascertain whether enhanced nitrite concentrations in the gastric fluid of patients having the described gastric disorders are liable to yield enhanced endogenous N-nitrosation rates, as measured by urinary excretion of NPRO.…”