a-00020 Dr. Robert RUTLEDGETitle of Paper: RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASS Nationality: United States of America Position: Director Department: Surgery Organization: Center For Laparoscopic Obesity Surgery Tel: +1-702 714 0011 E-mail: firstname.lastname@example.org
RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASS Robert RUTLEDGE11Director, Surgery, Center For Laparoscopic Obesity Surgery, United States of America
Gastric Cancer and Billroth II• Many surgeons not well informed about risks of gastric cancer (GCa).• The purpose of this study was to review the medical literature on the use of the Billroth II (B2) and the risk of GCa.
Methods:• Review of the medical literature on B2 and the risk of GCa.
Oxidative and genotoxic effects of 900 MHz Cell Phone electromagnetic fields• Exposure treatments induced significant genotoxic effect• DNA damaging capacity of 900 MHz electromagnetic radiation.• Induction of antioxidant stress response: Enhanced catalase and glutathione reductase activity• Lipid & Protein damage.Ecotoxicol Environ Saf. 2013 Apr;90:7-12. doi: 10.1016/j.ecoenv.2012.12.005.Epub 2013 Jan 24. Oxidative and genotoxic effects of 900 MHz electromagneticfields in the earthworm Eisenia fetida. Tkalec M,
Effects of the exposure to mobile phones on male reproduction• Human spermatozoa exposed to RF-EMR have• Decreased motility, morphometric abnormalities, and increased oxidative stress• Men using mobile phones• Decreased sperm concentration, decreased motility (particularly rapid progressive motility) and decreased viability.• These abnormalities seem to be directly related to the duration of mobile phone use.J Androl. 2012 May-Jun; Effects of the exposure to mobile phones on malereproduction: a review of the literature. La Vignera S, Section of Endocrinology,Andrology, and Internal Medicine
Meta-analyses Cell Phones Increase Risk of Brain Tumor• Three Meta-analyses Case-controlled Studies• Using cell phones Associated with• Increased Risk of Brain CancerElectromagn Biol Med. 2013 Jan 15. Cancer risks related to low-level RF/MWexposures, including cell phones. Szmigielski S.
Cellular neoplastic transformationinduced by 916 MHz microwave radiation• Investigation cellular neoplastic transformation effects of Cell Phone electromagnetic fields• Animal carcinogenesis Masses developed mice after being inoculated into Cell Phone cells for more than 4 weeks.• “Microwave radiation promotes neoplastic transformation of NIH/3T3cells”Cell Mol Neurobiol. 2012 Aug; Cellular neoplastic transformation induced by 916MHz microwave radiation. Yang L, Beijing, Peoples Republic of China.
PRIMITIVE RESPONSE SYSTEMS MODIFY RISK ASSESSMENT: Fear of Gastric Cancer
Results Six Main Findings: #1• 1-GCa rates are DECLINING RAPIDLY around the world, > 50%
Six Main Findings: #2 Cause & Prevention• 2-GCa Cause & Prevention:• Cause: Modifiable Environmental Factors Diet, Lifestyle & H. Pylori• Prevention: Avoid: Etoh, Tobacco, Processed & salted meats & foods Encourage: Fruits & vegetables & Rx H. Pylori.
Six Main Findings: #3Many Large Studies: No Increase Risk GCa after B2• 3-Many Large Studies• No Increased Risk in GCa after B2.• E.G. Mayo Clinic Study
Six Main Findings: #4Some Studies: DO Show Increase Risk GCa after B2 • 4-Some studies *Do* show slight Increased risk of GCa 20-30 years after B2 (RR 1.5), • But: B2 performed to Rx Ulcer; Ulcer (H. Pylori) Increases Risk GCa
Six Main Findings: #5 Endoscopic Screening of B2 Not Recommended• 5-Endoscopic screening of B2 patients is generally *Not* recommended because of Low Risk.• Studies from Australia, USA and Europe• Routine Endoscopic follow up• “Not Rewarding”
RISK OF GASTRIC CANCERAFTER BILLROTH II IS LOW• Follow-up study of 1000 B2 patients• 22-30 year follow-up• 196 endoscopy and biopsy No Cancer of the gastric remnant seen• Endoscopic screening will be “unrewarding”• Br J Surg. 1983 Sep;70(9):552-4. Risk of gastric cancer after Billroth II resection for duodenal ulcer. Fischer AB
Six Main Findings: #6 Surgeons Routinely use the B2• 6-General, Trauma and Oncologic surgeons Routinely use the B2.• In 2007 16,000 B2 procedures performed in USA.• The B2 is widely used reconstruction after distal gastric resection• (Billroth II in use for over 100 years & over 1,400 reporteds)
Confusing Statistical With Clinical Significance• Statistical Significance CONFUSED with Clinical Relevance!• Possible and Common to have Clinically INSIGNIFICANT results that are Statistically Significant.• LARGE Sample Size Effect: “Given a sufficiently large sample size, a statistical comparison will always show a significant difference unless the population effect size is exactly zero”
Danger of the Hot Dog!!!• “Meat intake and risk of stomach and esophageal adenocarcinoma within the European Prospective Investigation Into Cancer and Nutrition (EPIC)”• AU: González CA, et.al.• SOJ Natl Cancer Inst. 2006;98(5):345.
Danger of the Hot Dog!!!• 521,457 pts; 10 European countries (EPIC)• 6 years Follow up• 50-g/day increase Processed Meat Risk of Gastric Cancer Risk Significantly increased RR = 2.5
Danger of the Hot Dog!!!• 50 g processed meat = Increased RR Gastric Cancer 2.5• One Hot Dog = 50 g
CANCER QUIZ:MORE DEADLY CANCER CAUSING AGENT? AOR B
Danger of the Hot Dog!!!• One Hot Dog 50 g • Billroth II• Follow-up **6.5 yr** • Follow up **30 yr**• 50 g processed meat • Inc RR 1.5 = Inc RR 2.5
Survey 112 Bariatric Surgeons• 89% Said:• Hot Dog was More Dangerous Billroth II
Conclusions:• 1. Gastric Cancer declining rapidly• 2. Primarily related to environmental factors; Avoid Etoh, Tobacco, processed & salted meats and foods; Encourage high intake of fruits & vegetables and Rx H. Pylori• 3. Many Studies Show No Increased Risk (Mayo Clinic 1983)
Conclusions:• 4. Some Studies Show Increased Risk of GCA after B2 related to Ulcer & H. Pylori• 5. Endoscopic screening is not recommended.• 6. While some bariatric surgeons have expressed fears of the B2 causing cancer; General and Oncologic Surgeons continue to routinely use the B2.
Fear Gastric Cancer?• The Hot Dog more Dangerous than BII
Fear of Cell Phones?Fear of Gastric Cancer after B2?