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Is Esophageal Adenocarcinoma Occurring Late After Antireflux Surgery Due to Persistent Postoperative Reflux?

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Abstract

Background

Gastroesophageal reflux is the main risk factor for esophageal adenocarcinoma, but there is no strong support for a protective effect of antireflux surgery. We tested the hypothesis that esophageal adenocarcinoma that develops with long latency after antireflux surgery might be due to persistent postoperative reflux.

Methods

A nationwide population-based case-control study in collaboration with 195 relevant Swedish hospital departments and tumor registries during the study period 1995–1997. Frequency-matched control persons were randomly selected from the population register. All study participants were personally interviewed regarding background data, exposures, symptoms, conditions, diseases, surgery, and medications. Differences between cases and controls in the occurrence of daily, long-standing antireflux medication 5 years or later after antireflux surgery were estimated using Fisher’s exact test.

Results

One hundred and eighty-nine out of 216 (88%) eligible cases of esophageal adenocarcinoma and 820 of 1,128 (73%) controls were prospectively enrolled. Seven (3.7%) patients and 8 controls had undergone antireflux surgery at least 5 years before the interview. All 7 case patients had Barrett’s mucosa. Four of the case patients had used postoperative antireflux medications continuously (mean duration 10.2 years), while none of the control persons reported such use (P = 0.026). There was no difference in mean body mass index between patients with and without postoperative reflux (P = 0.81). No differences between the patients and controls were found regarding age, sex, body mass index, or tobacco smoking status.

Conclusions

Esophageal adenocarcinoma occurring late after antireflux surgery might at least partly be due to persistent postoperative reflux. Further research is required to establish the role of antireflux surgery in the etiology of this tumor.

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References

  1. Blot WJ, Devesa SS, Kneller RW, et al. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991;265(10):1287–1289

    Article  PubMed  CAS  Google Scholar 

  2. Chow WH, Finkle WD, et al. The relation of gastroesophageal reflux disease and its treatment to adenocarcinomas of the esophagus and gastric cardia. JAMA 1995;274(6):474–477

    Article  PubMed  CAS  Google Scholar 

  3. Lagergren J, Bergstrom R, Lindgren A, et al. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999;340(11):825–831

    Article  PubMed  CAS  Google Scholar 

  4. Spechler SJ. Clinical practice. Barrett’s esophagus. N Engl J Med 2002;346(11):836–842

    Article  PubMed  Google Scholar 

  5. Shaheen N, Ransohoff DF. Gastroesophageal reflux, Barrett esophagus, and esophageal cancer: scientific review. JAMA 2002;287(15):1972–1981

    Article  PubMed  Google Scholar 

  6. Csendes A, Burdiles P, Braghetto I, et al. Adenocarcinoma appearing very late after antireflux surgery for Barrett’s esophagus: long-term follow-up, review of the literature, and addition of six patients. J Gastrointest Surg 2004;8(4):434–441

    Article  PubMed  Google Scholar 

  7. Corey KE, Schmitz SM, Shaheen NJ et al. Does a surgical antireflux procedure decrease the incidence of esophageal adenocarcinoma in Barrett’s esophagus? A meta-analysis. Am J Gastroenterol 2003;98(11):2390–2394

    Article  PubMed  Google Scholar 

  8. Ye W, Chow WH, Lagergren J, et al. Risk of adenocarcinomas of the esophagus and gastric cardia in patients with gastroesophageal reflux diseases and after antireflux surgery. Gastroenterology 2001;121(6):1286–1293

    Article  PubMed  CAS  Google Scholar 

  9. Spechler SJ, Lee E, Ahnen D, et al. Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. JAMA 2001;285(18):2331–2338

    Article  PubMed  CAS  Google Scholar 

  10. Lagergren J, Bergstrom R, Adami HO, et al. Association between medications that relax the lower esophageal sphincter and risk for esophageal adenocarcinoma. Ann Intern Med 2000;133(3):165–175

    PubMed  CAS  Google Scholar 

  11. Brand DL, Ylvisaker JT, Gelfand M, et al. Regression of columnar esophageal (Barrett’s) epithelium after anti-reflux surgery. N Engl J Med 1980;302(15):844–848

    Article  PubMed  CAS  Google Scholar 

  12. Oberg S, Wenner J, Johansson J, et al. Barrett esophagus: risk factors for progression to dysplasia and adenocarcinoma. Ann Surg 2005;242(1):49–54

    Article  PubMed  Google Scholar 

  13. Oelschlager BK, Barreca M, Chang L, et al. Clinical and pathologic response of Barrett’s esophagus to laparoscopic antireflux surgery. Ann Surg 2003;238(4):458–464; discussion 464–456

    PubMed  Google Scholar 

  14. Desai KM, Soper NJ, Frisella MM, et al. Efficacy of laparoscopic antireflux surgery in patients with Barrett’s esophagus. Am J Surg 2003;186(6):652–659

    Article  PubMed  Google Scholar 

  15. Spechler SJ. Comparison of medical and surgical therapy for complicated gastroesophageal reflux disease in veterans. The Department of Veterans Affairs Gastroesophageal Reflux Disease Study Group. N Engl J Med 1992;326(12):786–792

    Article  PubMed  CAS  Google Scholar 

  16. Fitzgerald RC, Omary MB, Triadafilopoulos G. Dynamic effects of acid on Barrett’s esophagus. An ex vivo proliferation and differentiation model. J Clin Invest 1996;98(9):2120–2128

    Article  PubMed  CAS  Google Scholar 

  17. Ouatu-Lascar R, Fitzgerald RC, Triadafilopoulos G. Differentiation and proliferation in Barrett’s esophagus and the effects of acid suppression. Gastroenterology 1999;117(2):327–335

    Article  PubMed  CAS  Google Scholar 

  18. Lagergren J, Bergstrom R, Hyrin O. Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Ann Intern Med 1999; 9(4):369–378

    Google Scholar 

  19. Chow WH, Blot WJ, Vaughan TL, et al. Body mass index and risk of adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst 1998;90(2):150–155

    Article  PubMed  CAS  Google Scholar 

  20. Nilsson M, Johnsen R, Ye W, et al. Obesity and estrogen as risk factors for gastroesophageal reflux symptoms. JAMA 2003;290(1):66–72

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

Funding was provided by the Swedish Cancer Society and the Swedish Research Council.

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Authors and Affiliations

  1. Unit of Esophageal and Gastric Research (ESOGAR), Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Jesper Lagergren MD, PhD & Pernilla Viklund RN

  2. Department of Surgery P9:03, Karolinska University Hospital, SE-171 76, Stockholm, Sweden

    Jesper Lagergren MD, PhD

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  1. Jesper Lagergren MD, PhD
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  2. Pernilla Viklund RN
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Correspondence to Jesper Lagergren MD, PhD.

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Lagergren, J., Viklund, P. Is Esophageal Adenocarcinoma Occurring Late After Antireflux Surgery Due to Persistent Postoperative Reflux?. World J. Surg. 31, 465–469 (2007). https://doi.org/10.1007/s00268-006-0386-9

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  • DOI: https://doi.org/10.1007/s00268-006-0386-9

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