Journal of Clinical Pathology 2002;55:340-345.

Ulcer surgery linked to risk of pancreatic cancer

By Alison McCook

NEW YORK, Apr 30 (Reuters Health) - Patients who undergo surgery to remove their ulcers may be at increased risk of later developing pancreatic cancer, new research suggests.

The investigators base their findings on an analysis of 2,633 patients who underwent an operation known as gastrectomy to remove their ulcers. Peptic ulcers are sores located in the lining of the stomach or a portion of the small intestine, called the duodenum. Often ulcers are treated with antibiotics, but some patients require surgery. During a gastrectomy, the surgeon removes part of the stomach, as well as some of the tissue around the stomach.

It has been suggested that patients who undergo peptic ulcer surgery may be at increased risk of pancreatic cancer, but previous studies have shown conflicting results.

In this study, Dr. Johan Offerhause and colleagues found that patients with peptic ulcers who underwent surgery at the academic medical center of the University of Amsterdam in the Netherlands had an almost twofold higher risk of developing pancreatic cancer up to 59 years after the procedure than those in the general Dutch population.

Furthermore, that risk appears to increase with time following the surgery, with those who survived 35 years after peptic ulcer surgery having more than triple the risk of developing pancreatic cancer.

In total, 39 patients from the original sample have died from pancreatic cancer, according to the report published in the May issue of the Journal of Clinical Pathology.

In an interview with Reuters Health, Offerhause said that peptic ulcer surgery may help induce pancreatic cancer by reducing the amount of acid the stomach produces. This creates a friendly environment for certain bacteria that have been linked to pancreatic cancer.

In addition, smoking is a significant risk factor for the development of both pancreatic cancer and peptic ulcers. That means that many patients who undergo ulcer surgery may smoke and not quit following surgery. Consequently, "it is important to quit smoking in the first place," Offerhause said.

Offerhause added that patients who have previously undergone surgery to remove their peptic ulcers should see their doctors if they begin to experience any unexplained symptoms, or if they have complaints such as loss of appetite or fatigue. Pancreatic cancer is often difficult to treat, so identifying any patients who might be at increased risk of the disease may help detect the disease before it becomes untreatable, the authors note.

SOURCE: Journal of Clinical Pathology 2002;55:340-345.

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