You are here

Previous Gastrectomy

It has been reported by several groups that gastric surgery for benign conditions can predispose patients to a higher risk of gastric cancer, beginning 20 years after the surgery.223-226 The risk is greatest for those who underwent surgery before the age of 50 years, perhaps reflecting the long lag period necessary between the operation and the development of cancer.224 The cancers tend to occur at or near the surgical anastomosis on the gastric side; only rarely do they reside on the intestinal side of the anastomosis.227

remaining fundic mucosa due to low levels of antral hormones, including gastrin.14,228,229 The Billroth II operation with gastrojejunostomy predisposes to the development of cancer at a 4-fold higher rate than a Billroth I procedure with gastroduodenostomy, suggesting that bile reflux may be a significant predisposing factor.224 Hp and associated intestinal metaplasia are found less frequently in postgastrectomy gastric cancers as compared to distal gastric cancers in the nonoperative stomach.230 It is unclear whether screening for gastric cancer in this population of patients in areas of low cancer incidence would be cost-effective. With the advent of Hp eradication therapy as well as PPIs, the number of gastric resections for peptic ulcer disease has decreased dramatically, significantly reducing the impact of the postgastrectomy state as a risk factor for gastric cancer.