Apc RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASS

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RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASS …

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: drr@clos.net

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  • 1. a-00020 Dr. Robert RUTLEDGE Title 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: drr@clos.net All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 2. RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASS Robert RUTLEDGE1 1Director, Surgery, Center For Laparoscopic Obesity Surgery, United States of America All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 3. 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. All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 4. Methods: • Review of the medical literature on B2 and the risk of GCa. All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 5. Cell Phones & Fear All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 6. 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 electromagnetic fields in Available Online: http://www.SLIDESHARE.NET/DRRRMD All Slides the earthworm Eisenia fetida. Tkalec M, Email: DRR@CLOS.NET
  • 7. 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 male reproduction: a review of the literature. La Vignera S, Section of Endocrinology, Andrology, and Internal Medicine All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 8. Meta-analyses Cell Phones Increase Risk of Brain Tumor • Three Meta-analyses Case-controlled Studies • Using cell phones Associated with • Increased Risk of Brain Cancer Electromagn Biol Med. 2013 Jan 15. Cancer risks related to low-level RF/MW exposures, including cell phones. Szmigielski S. All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 9. Cellular neoplastic transformation induced 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 916 MHz microwave radiation. Yang L, Beijing, People's Republic of China. All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 10. PRIMITIVE RESPONSE SYSTEMS MODIFY RISK ASSESSMENT: Fear of Gastric Cancer All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 11. Results Six Main Findings: #1 • 1-GCa rates are DECLINING RAPIDLY around the world, > 50% All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 12. 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. All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 13. Six Main Findings: #3 Many Large Studies: No Increase Risk GCa after B2 • 3-Many Large Studies • No Increased Risk in GCa after B2. • E.G. Mayo Clinic Study All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 14. Six Main Findings: #4 Some 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 All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 15. 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” All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 16. RISK OF GASTRIC CANCER AFTER 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 All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 17. 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) All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 18. 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” All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 19. Danger of the Hot Dog!!! All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 20. 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. All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 21. 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 All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 22. Danger of the Hot Dog!!! • 50 g processed meat = Increased RR Gastric Cancer 2.5 • One Hot Dog = 50 g All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 23. CANCER QUIZ: MORE DEADLY CANCER CAUSING AGENT? A OR B All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 24. Danger of the Hot Dog!!! • One Hot Dog 50 g • Follow-up **6.5 yr** • Billroth II • Follow up **30 yr** • 50 g processed meat = Inc RR 2.5 • Inc RR 1.5 All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 25. Survey 112 Bariatric Surgeons • 89% Said: • Hot Dog was More Dangerous Billroth II All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 26. 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) All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 27. 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. All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 28. Fear Gastric Cancer? • The Hot Dog more Dangerous than BII All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET
  • 29. Fear of Cell Phones? Fear of Gastric Cancer after B2? All Slides Available Online: http://www.SLIDESHARE.NET/DRRRMD Email: DRR@CLOS.NET