Cancer of the stomach after operation for benign ulcer disease

Despite a great number of studies during almost three decades it has not been possible to satisfactorily answer the question how the risk of developing cancer of the stomach is affected by operation for ulcer disease. The answer to this question is interesting from a tumourbiological point of view and practically important when choosing treatment and follow-up routines. In principle this can be said to be a test case for clinical problems that can be solved most effectively by epidemiological research methods. In this brief survey are summarized first the state of knowledge in the field and the methodological problems that have made it hard to study the question. Then a historical cohort study is reported which has just been finished in the health care region of Uppsala. By following a sufficiently great number of individuals (fully 6,000) over a long time (25-33 years) and using multivariate methods of analysis it was possible to demonstrate a consistent and complex pattern of a changed risk of cancer of the stomach after partial gastrectomy according to Billroth I and II. Not only the choice of surgical method influences this risk but also age at operation, diagnosis, the length of the observational follow-up, and the sex of the patient.