The operated stomach: a premalignant condition? A prospective endoscopic follow-up study

2633 consecutive patients in whom a gastric operation had been performed between 1931 and 1960 were selected for an ongoing prospective follow-up study. In 741 already deceased patients mortality due to gastric cancer was 5.13%. 504 asymptomatic postgastrectomy patients participated in an endoscopic-bioptic screening program. Up to now, 10 stump cancers have been detected. Seven had a radical curative resection, and all are still alive. In five of them the cancer was limited to the mucosa and not visible at endoscopy. Gastric dysplasia was found in 70 patients. In three patients with severe dysplasia carcinoma was detected during follow-up study. In 22 patients with prior mild or moderate dysplasia no progression could be demonstrated. Cancer in postgastrectomy patients is estimated to be at least twice as high as in an age-matched Dutch control population with intact stomach. The risk depends on the postoperative interval and the age at which the initial operation was performed. In general, patients from the age of 50 onwards or more than 10-15 years after initial surgery are at risk.