Malignancy following surgery for benign peptic disease: a review

Since 1986 there have been a number of large studies of cancer risk after surgery for benign disease involving over 20,000 patients followed for at least 20 years. All show that gastric surgery carries an excess risk of gastric cancer after a 15-20 year latency. There is less agreement about the excess risk at other sites. The size of such risks appears to depend on the size of cohort, type of ulcer, type of surgery, length of follow-up and level of analytical detail. Statistically significant excess risks have been reported for cancer of the colon (6/8 studies), biliary tract (4/5), lung (6/6), bladder (3/3), pancreas (4/7) and all sites (2/3). Our own study showed an excess risk of cancer of the gallbladder (14.3 fold), stomach (4.5), breast (4.0), bronchus (3.9), large bowel (1.6), oesophagus (2.3), pancreas (4.0), bladder (2.4) and all sites (3.3).