Gastric cancer after peptic ulcer surgery. A historic prospective cohort investigation

In a historical prospective cohort investigation of 4131 patients undergoing peptic ulcer surgery in 53 hospitals in the western part of Denmark from 1955 through 1960, the risk of subsequent gastric cancer development was studied. The patients were followed with regard to gastric cancer development until their death or the end of the year 1982 and the incidence of cancer in this cohort was compared to the incidence in the total population in the same region during the same period. A total of 46 gastric cancers were diagnosed versus 47 expected. Up to 15 years after operation the cancer risk was lower than expected. After 15 years the risk was higher than expected with a 2.1-fold higher incidence after 25 years for the total patient population. The highest risk was observed in male subjects undergoing a Billroth II subtotal gastrectomy with a 3.2 times increase in risk after 25 years. There was no difference between gastric and duodenal ulcer patients; and patients undergoing simple suture for a perforated ulcer showed no increase in cancer incidence. Patients with long-lasting symptoms had the same incidence as patients with briefer symptoms. These observations indicate that the operation per se and not the ulcer disease may be precancerous.