W C MacDonald1, D A Owen. 1. Division of Medical Oncology, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
BACKGROUND: Surgery for peptic ulcer is associated with an increased risk of later development of gastric carcinoma. This risk applies to cancer occurring in the distal stomach, not at the cardia. Mucosal alterations occurring in the nonneoplastic mucosa, adjacent to postgastrectomy carcinomas, are currently poorly defined. METHODS: Between 1975 and 1995, the authors collected records of 76 patients with gastric carcinoma developing after previous ulcer surgery. Thirty-three gastrectomy specimens were available for study and were compared with a control series of gastric carcinomas occurring in the intact stomach. Morphologic features studied were macroscopic findings, tumor type, extent of inflammation, atrophy, intestinal metaplasia, reactive gastropathy, and presence of Helicobacter pylori. When possible, a semiquantitative grading system (Sydney system) was used. RESULTS: The 33 patients with resected carcinoma after ulcer surgery were representative of the total 76 patients. There were no differences between the seven postulcer surgery cardia carcinomas and the control cardia carcinomas. The 18 distal carcinomas occurring after prior gastrectomy had significantly less intestinal metaplasia and Helicobacter pylori in the nonneoplastic mucosa than did the controls. Eight distal carcinomas occurring after a vagotomy and pyloroplasty had adjacent mucosa with findings intermediate between the gastrectomy carcinomas and the controls. CONCLUSIONS: The differences shown suggest that for distally located postgastrectomy carcinomas Helicobacter pylori infection with extensive intestinal metaplasia may be relatively less important in pathogenesis and that intestinal reflux with reactive gastropathy more important. There was no evidence to support a different mechanism of pathogenesis for postsurgical carcinomas occurring at the cardia from that of control cardia carcinomas. Copyright 2001 American Cancer Society.
BACKGROUND: Surgery for peptic ulcer is associated with an increased risk of later development of gastric carcinoma. This risk applies to cancer occurring in the distal stomach, not at the cardia. Mucosal alterations occurring in the nonneoplastic mucosa, adjacent to postgastrectomy carcinomas, are currently poorly defined. METHODS: Between 1975 and 1995, the authors collected records of 76 patients with gastric carcinoma developing after previous ulcer surgery. Thirty-three gastrectomy specimens were available for study and were compared with a control series of gastric carcinomas occurring in the intact stomach. Morphologic features studied were macroscopic findings, tumor type, extent of inflammation, atrophy, intestinal metaplasia, reactive gastropathy, and presence of Helicobacter pylori. When possible, a semiquantitative grading system (Sydney system) was used. RESULTS: The 33 patients with resected carcinoma after ulcer surgery were representative of the total 76 patients. There were no differences between the seven postulcer surgery cardia carcinomas and the control cardia carcinomas. The 18 distal carcinomas occurring after prior gastrectomy had significantly less intestinal metaplasia and Helicobacter pylori in the nonneoplastic mucosa than did the controls. Eight distal carcinomas occurring after a vagotomy and pyloroplasty had adjacent mucosa with findings intermediate between the gastrectomy carcinomas and the controls. CONCLUSIONS: The differences shown suggest that for distally located postgastrectomy carcinomas Helicobacter pylori infection with extensive intestinal metaplasia may be relatively less important in pathogenesis and that intestinal reflux with reactive gastropathy more important. There was no evidence to support a different mechanism of pathogenesis for postsurgical carcinomas occurring at the cardia from that of control cardia carcinomas. Copyright 2001 American Cancer Society.
Authors: Anna Carolina Batista Dantas; Marco Aurelio Santo; Roberto de Cleva; Rubens Antônio Aissar Sallum; Ivan Cecconello Journal: Cancer Biol Med Date: 2016-06 Impact factor: 4.248