By promoting duodenogastroesophageal reflux, gastric resection appears to increase the risk of laryngeal cancer, according to study findings published in the July issue of the Archives of Surgery.
Up to a third of patients who undergo total or partial gastrectomy will develop reflux, recent reports suggest. Such reflux is a well-known risk factor for esophageal cancer, but there is now evidence that it may also promote laryngeal cancer. Still, exactly how often laryngeal cancer occurs after gastric surgery is unclear.To investigate, Dr. Giovanni Cammarota and colleagues, from the Catholic University of Medicine and Surgery in Rome, compared the outcomes of 93 patients who underwent gastric resection with those of 93 matched subjects who did not undergo surgery.Indirect laryngoscopy was performed in both groups at least 5 years after the surgical patients were treated. The surgical indications included peptic ulcer disease in 89 patients and gastric cancer in 4.In the surgery group, seven patients had malignant or premalignant laryngeal lesions. In contrast, only one case of vocal cord leukoplakia was noted in the control group, the researchers state.After adjusting for sex, age, alcohol use, and smoking status, surgical patients were nearly 10 times more likely than controls to develop a malignant or premalignant laryngeal lesion (p < 0.001). Moreover, the researchers found that surgical patients were also at increased risk for benign lesions.Despite the elevated risks, it appears that laryngeal neoplasia takes many years to develop following gastric resection. In the current cohort, the minimum period from gastric resection to the detection of cancerous or precancerous lesions was 22 years, the authors note. "This study, although small, is the first, to our knowledge, that suggests the development of laryngeal malignancy or premalignancies as long-term complications of gastric surgery," the authors state. Based on this, "a periodic otolaryngologic evaluation in subjects with gastric surgery may contribute to early diagnosis of laryngeal disorders."(Source: Arch Surg 2003;138:751-754: Reuters Health: July 23, 2003: Oncolink)