Partial gastrectomy: a risk factor for carcinoma of the pancreas?

Recent reports suggest an increased risk of cancer of the pancreas after partial gastrectomy. We investigated this putative relationship by performing a case-control study on autopsy subjects. Our findings suggest a three-fold risk of pancreatic carcinoma in postgastrectomy patients. Increased production of carcinogens in the gastric remnant, excretion of the carcinogens by the liver into the bile, and subsequent bile reflux into the pancreatic duct is proposed as a working hypothesis for pancreatic carcinogenesis. This study illustrates the usefulness of autopsy series as an instrument for checking a straightforward hypothesis before designing more extensive and expensive studies. Moreover, efficient use of autopsy data was accomplished by computerized data base retrieval of autopsy records, emphasizing that this method of record retrieval is an important precondition for prospective studies.