RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASS Nationality: United States of America Position: DirectorDepartment: SurgeryOrganization: Center For Laparoscopic Obesity SurgeryTel: +1-702 714 0011E-mail: drr@clos.net

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
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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
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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.
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Email: DRR@CLOS.NET

4. Methods:
• Review of the medical literature on B2 and
the risk of GCa.
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5. Cell Phones & Fear
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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
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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.
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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.
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10. PRIMITIVE RESPONSE SYSTEMS
MODIFY RISK ASSESSMENT:
Fear of Gastric Cancer
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11. Results Six Main Findings: #1
• 1-GCa rates are DECLINING RAPIDLY
around the world, > 50%
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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.
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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
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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
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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”
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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
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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)
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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”
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19. Danger of the Hot Dog!!!
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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.
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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
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22. Danger of the Hot Dog!!!
• 50 g processed meat
=
Increased
RR
Gastric Cancer
2.5
• One Hot Dog = 50 g
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23. CANCER QUIZ:
MORE DEADLY CANCER CAUSING AGENT? A
OR B
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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
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25. Survey 112 Bariatric Surgeons
• 89% Said:
• Hot Dog was More Dangerous Billroth II
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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)
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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.
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28. Fear Gastric Cancer?
• The Hot Dog more Dangerous than BII
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29. Fear of Cell Phones?
Fear of Gastric Cancer after B2?
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