Gastrectomy Increases Risk for Esophageal Adenocarcinoma and Gastric Cardia Adenocarcinoma: An Explorys Study

Abstract

Introduction: Recent studies in patients who have undergone gastrectomy, primarily sleeve gastrectomy (SG),suggests the procedure exacerbates underlying gastroesophageal reflux disease (GERD) or may even lead to new GERD. Smaller studies have linked SG with the development of Barrett's Esophagus (BE). Current studies do not suggest that Roux-en-Y gastrectomy (RYG) exacerbates GERD, or leads to BE. However, there are no studies evaluating gastrectomy, mostly sleeve gastrectomy today, with the risk of developing either EA or gastric cardia adenocarcinoma (GCA). Aim: to determine if there was any association between gastrectomy or Roux-en-Y with either the development of EA or GCA, using the Explorys database. Methods: We performed a population-based analysis through the Explorys database. Explorys is an aggregate electronic medical record database representing over 54 million patients. It identifies diagnosis, procedures, and test results. Search terms such as neoplasm of lower third of esophagus (NLT) and neoplasm of cardia of stomach (NCS) were used to identify EA and GCA. We used GERD only as the disease control group and identified population cohorts with GERD that also had the diagnosis of BE, gastrectomy or Roux-en-Y. We used temporal attributes to delineate the order of diagnosis and procedure, where patients had to have GERD and the other diagnosis or intervention, prior the diagnosis of EA or GCA. Results: We found that populations of GERD who underwent gastrectomy, mostly sleeve, had an increased association with NCS with OR 13.73 (95% CI 12.07 - 15.62, P<0.0001) and RR 13.64 (95% CI 12.00 - 15.50, P<0.0001) and an increased association with NLT with OR 2.74 (95% CI 2.17 - 3.48, P<0.0001) and RR 2.75 (95% CI 2.17 - 3.48, P<0.0001). There was no association between Roux-en-Y and either NCS or NLT. In contrast, GERD with BE had an increased association with NCS with OR 4.70 (95% CI 4.16 - 5.30, P<0.0001) and RR4.69 (95% CI 4.15 - 5.29, P<0.0001) and an increased association with NLT with OR of 5.47 (95% CI 4.93 - 6.06, P<0.0001) and RR 5.45 (95% CI 4.92 - 6.04, P<0.0001). Conclusion: Patients with GERD who underwent gastrectomy, mostly sleeve, are at an increased risk for developing EA and GCA. In contrast, there was no association between GERD patients who underwent Roux-en-Y bypass gastrectomy with either EA or GCA. Further studies evaluating the risk of gastrectomy for GCA and EA are needed, especially in patients undergoing sleeve gastrectomy.