Stalnikowicz R, Benbassat J
Department of Medicine, Hadassah University Hospital-Mount Scopus, Jerusalem, Israel.
Arch Intern Med. 1990 Oct;150(10):2022-6.
The objective of this review was to evaluate published evidence for the association between gastric resection for benign disorders and subsequent cancer of the gastric remnant. We searched the literature through Medline (1970 to 1988) and through the references of relevant articles. Fifty-eight studies consisting of case series, uncontrolled surveys, and case control or cohort analyses were identified and critically assessed using defined methodological criteria. There were no consistent differences between the expected and observed number of cancers occurring within 15 years after gastric resection. However, all case control studies and seven of the eight cohort analyses, in which the prevalence of cancer was stratified by time since gastric resection, indicated a twofold to fourfold increase in the risk of gastric cancer in patients who survived 15 or more years after gastric surgery. We conclude that most studies of the association of gastric surgery with subsequent gastric cancer have relatively weak designs. Still, the repetitive demonstration of this association by different investigators using different research designs supports the hypothesis that gastric resection increases the risk of cancer in the gastric remnant.
本综述的目的是评估已发表的关于良性疾病胃切除术与随后残胃癌之间关联的证据。我们通过Medline（1970年至1988年）以及相关文章的参考文献检索文献。共识别出58项研究，包括病例系列、无对照调查以及病例对照或队列分析，并使用既定的方法学标准进行了严格评估。胃切除术后15年内发生的癌症预期数量与观察数量之间没有一致的差异。然而，所有病例对照研究以及八项队列分析中的七项（其中癌症患病率按胃切除术后时间分层）表明，胃切除术后存活15年或更长时间的患者患胃癌的风险增加了两倍至四倍。我们得出结论，大多数关于胃手术与随后胃癌关联的研究设计相对薄弱。尽管如此，不同研究者使用不同研究设计对这种关联的反复证明支持了胃切除术会增加残胃癌风险这一假说。
