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Meta-Analysis of the Risk of Gastric Stump Cancer: Detection of High Risk Patient Subsets for Stomach Cancer after Remote Partial Gastrectomy for Benign Conditions¹

Departments of Clinical Epidemiology [A. C. T, J. P. V] and Pathology [G. J. A. O., K. W. F. T.], University Hospital, Leiden, The Netherland; Departments of Epidemiology [A. C. T.], Pathology [G. J. A. O., G. W. M.], and Medicine [F. M. G.], The Johns Hopkins University, Baltimore, Maryland, 21205; and Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands [G. N. J. T.]

Controversy about gastric cancer risk after partial gastrectomy exists, especially in the United States. Therefore, we performed a meta-analysis to determine overall relative risk and weighted mean relative risk for subsets of postgastrectomy patients, define possible high risk patients suitable for surveillance, and assess for publication bias which would overestimate risk.

If 2 studies were excluded because of heterogeneity, overall relative risk (RR) for gastric stump cancer in 22 studies analyzed was 1.66 [95% confidence limits (CL), 1.54–1.79]. With these 2 studies included, the RR summarized with a random effects model to account for study heterogeneity was 1.46 (95% CL, 1.18–1.82). No obvious evidence of publication bias was detected. Patients 15 years or more postoperative had a weighted mean RR of 1.48 (95% CL, 1.31–1.67) and patients 5–14 years postoperative had a RR of 0.91 (95% CL, 0.71–1.17) (P = 0.026). Patients operated upon for gastric ulcer had a weighted mean RR of 2.12 (95% CL, 1.73–2.59) and patients with duodenal ulcers had a RR of 0.84 (95% CL, 0.66–1.05) (P = 0.001). The weighted mean RR for females was 1.79 (95% CL, 1.39–2.29) and for males 1.43 (95% CL, 1.27–1.62) (P = 0.074). For Billroth II gastrectomy the weighted mean RR was 1.60 (95% CL, 1.15–2.18) and for Billroth I gastrectomy 1.20 (95% CL, 1.01–1.42) (P = 0.220).

Although differences in risk between subsets of postgastrectomy patients seem to exist, recommendations concerning endoscopic surveillance await further studies of cost-benefit analysis.

¹ Supported by Grant WD 8803B of The Netherlands Digestive Diseases Foundation. Also supported by the Clayton Fund and the McAshan Fund.

² A. C. T. is a visiting scholar of the Department of Epidemiology of The Johns Hopkins University.

³ G. J. A. O. is a recipient of a gastrointestinal-pathology fellowship at The Johns Hopkins Hospital by the Netherlands Organization for Scientific Research and by the Netherlands Digestive Diseases Foundation. To whom requests for reprints should be addressed, at Carnegie, Room 214, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21205.

Received 3/27/90. Accepted 7/13/90.

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