Abstract
Partial gastrectomy for benign ulcer disease may influence future risk of death, eg, through changes in life-style or metabolism. To reveal such possible long-term effects, we analyzed a population-based cohort of 6459 patients operated on from 1950 through 1958 and followed through 1985. We found a lower overall mortality than in the general Swedish population (standardized mortality ratio = 0.94; 95% confidence interval 0.91–0.97). Mortality was decreased among those with duodenal ulcers, Billroth II operations, and older age at operation but increased as time passed after operation. Mortality was significantly (P<0.05) increased from tuberculosis, alcoholism, emphysema, stomach ulcer, intestinal obstruction, gallbladder or biliary disease, suicide, and accidental falls but decreased from ischemic heart disease and cerebrovascular disease. Preoperative selection of healthy patients and the probable increased prevalence of risk factors for ulcer disease (smoking, alcoholism, and lower socioeconomic status) in this cohort explain most of these findings. Apart from intestinal obstruction, gallbladder or biliary tract diseases, and tuberculosis, the surgical procedure did not appear to increase mortality beyond one year after operation.
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References
Nyhus LM, Wastell C: Surgery of the stomach and duodenum. Boston, Little, Brown and Company, 1977
Mellström D, Rundgren Å: Long-term effects after partial gastrectomy in elderly men: A longitudinal population study of men between 70 and 75 years of age. Scand J Gastroenterol 17:433–439, 1982
Krause U: Late prognosis after partial gastrectomy for ulcer. Acta Chir Scand 144:341–354, 1958
Westlund K: Mortality of peptic ulcer patients. Acta Med Scand 174(suppl 402), 1963
Asano A, Mizuno S, Sasaki R, Aoki K, Yokoyama H, Yokoyama Y: The long-term prognosis of patients gastrectomized for benign gastroduodenal diseases. Jpn J Cancer Res (Gann) 78:337–348, 1987
Fischer AB, Knop J, Graem N: Late mortality following Billroth II resection for duodenal ulcer. Acta Chir Scand 151:43–47, 1985
Ross AHM, Smith MA, Anderson JR, Small WP: Late mortality after surgery for peptic ulcer. N Engl J Med 307:519–522, 1982
Eriksson SBS: The operated stomach. Lund, Sweden, University of Lund, Bulletin No. 36, 1983
Stemmermann GN, Heilbrun L, Nomura A, Rhoads GG, Glober GA: Late mortality after partial gastrectomy. Int J Epidemiol 13:299–303, 1984
Lundegårdh G, Adami HO, Helmick C, Zack M, Meirik O: Stomach cancer following partial gastrectomy for benign ulcer disease. N Engl J Med 319:195–200, 1988
Bailar JC III, Ederer F: Significance factors for the ratio of a Poisson variable to its expectation. Biometrics 20:693–743, 1964
Frome EL, Checkoway H: Use of Poisson regression models in estimating incidence rates and ratios. Am J Epidemiol 121:309–323, 1985
Songre L, Mitsuo I, Tsuneyoski Y, Saburo S, Masatoshi F, Havuya O: Long-term follow-up of 2529 patients with gastric and duodenal ulcer: Survival rate and causes of death. Gastroenterology 94:381–386, 1988
Adami HO, Bergström R, Nyrén O, Forhaug K, Gustavsson S, Lööf L, Nyberg A: Is duodenal ulcer really a psychosomatic disease? A population-based case-control study. Scand J Gastroenterol 22:889–896, 1987
Glober GA, Thoads GG, Lin F, Kagan A: The effect of partial gastrectomy on lipoproteins and other characteristics. J Chron Dis 38:609–615, 1985
Kurata JH, Hile BM: Epidemiology of peptic ulcer disease. Clin Gastroenterol 13:289–307, 1984
Doll R, Peto R: Mortality in relation to smoking: 20 years' observations on male British doctors. Br Med J 2:1525–1536, 1976
Näyhä S: Social group and mortality in Finland. Br J Prev Soc Med 31:231–237, 1977
Meurling S: Postcibal symptoms after partial gastrectomy for peptic ulcer. Uppsala, Sweden, Almqvist & Wiksell, 1953
Stemmermann GN, Chyon PH, Kagan A, Nomura AM, Yano K: Serum cholesterol and mortality among Japanese-American men. The Honolulu (Hawaii) Heart Program. Arch Intern Med 151:969–972, 1991
Caygill CRJ, Hill MJ, Kirkham JS, Northfields TC: Increased risk of cancer at multiple sites after gastric surgery for peptic ulcer. Gut 28:924–928, 1987
Tersmette AC, Offerhaus GJ, Giardiello FM, Tersmette KW, Vandenbroucke JP, Tytgat GN: Occurrence of nongastric cancer in the digestive tract after remote partial gastrectomy: Analysis of an Amsterdam cohort. Int J Cancer 46:792–795, 1990
Knop J, Fischer A: Duodenal ulcer, suicide, psychopathology and alcoholism. Acta Psychiatr Scand 63:346–355, 1981
Muldoon MF, Manuck SB, Matthews KM: Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials. BMJ 301:309–314, 1990
Lundegårdh G, Adami HO, Helmick C, Zack M: The risk of large bowel cancer following partial gastrectomy for benign ulcer disease. Ann Surg 212:714–719, 1990
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Supported by grants from NIH/NCI (No. 5 R01 CA40264-02) and the Swedish Cancer Society.
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Lundegårdh, G., Helmick, C., Zack, M. et al. Mortality among patients with partial gastrectomy for benign ulcer disease. Digest Dis Sci 39, 340–346 (1994). https://doi.org/10.1007/BF02090206
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DOI: https://doi.org/10.1007/BF02090206