323,676 person-years at risk, After 30 Years, 140 cases gastric cancer

Int J Cancer. 2012 Apr 24. doi: 10.1002/ijc.27614. [Epub ahead of print]

Gastric stump cancer after distal gastrectomy for benign gastric ulcer in a population-based study.


Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Division of Cancer Studies, King’s College London, London, United Kingdom. jesper.lagergren@ki.se.


The risk of cancer in the gastric remnant after distal gastrectomy for benign ulcer disease has been assessed mainly in studies of small sample size, selected series and limited follow-up time. This was a population-based cohort study of patients who had undergone distal gastrectomy for benign ulcerdisease in 1964-2008 in Sweden. Data for follow-up for cancer and censoring for death were obtained from nationwide registries of Cancer and Population, respectively. The number of observed cancer cases in the gastrectomy cohort was divided by the expected number, calculated from the cancer incidence of the Swedish population of corresponding age, sex and calendar year. Relative risks were presented as standardized incidence ratios (SIR) with 95% confidence intervals (CI). The distal gastrectomy cohort included

18,912 patients and 323,676 person-years at risk.

The observed TOTAL number of gastric stump cancers (n=140) was not higher than expected (SIR 0.84, 95%CI 0.71-0.99).

There was no increased SIR with latency periods shorter than 30 years; increase was seen only among patients who had undergone gastric resection over 30 years earlier (SIR 2.29, 95%CI 1.38-3.57).

Sex, age, ulcer location, and type of surgical reconstruction were not associated with any considerable differences in SIR. In conclusion, this large population-based study revealed an increased risk of cancer in the gastric remnant only 30 years or longer after gastric resection for benign disease, while otherfactors did not influence this risk.


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