The lack of association between adenocarcinoma of the esophagus and gastric surgery: a retrospective study

Abstract

Background: The cause of the rapid increase in the incidence of adenocarcinoma of the esophagus since the 1970s is unknown.

Objective: To test the hypothesis that duodenogastroesophageal reflux causes adenocarcinoma of the esophagus by comparing the frequency of gastric surgery (a human model of duodenogastroesophageal reflux) and other potential risk factors between patients with adenocarcinoma and patients with squamous cell carcinoma of the esophagus.

Methods: Medical records of all patients with adenocarcinoma or squamous cell carcinoma of the esophagus seen at the Cleveland Clinic Foundation between 1987 and 1994 were reviewed. The following data were retrieved: age, gender, race, tumor location, history of gastric surgery and gastroesophageal reflux symptoms, and use of tobacco, alcohol, histamine-2 receptor antagonists, and proton pump inhibitors.

Results: The data of 325 patients with adenocarcinoma (73.5%) and 117 patients with squamous cell carcinoma (26.5%) were analyzed. No differences were found between the groups in age, proportion with gastric surgery (patients with adenocarcinoma: 1.2%, 95% confidence interval 0.3-3.1%; patients with squamous cell carcinoma: 0.9%, 95% confidence interval 0.0-4.7%), smoking (76.7 vs 81.6%), or alcohol use (71.8 vs 79.1%). Significant risk factors associated with adenocarcinoma of the esophagus were male gender, white race, distal cancer location, and Barrett's esophagus.

Conclusions: Previous gastric surgery is rarely found in patients with esophageal cancer and is performed with equal frequency in patients with adenocarcinoma and those with squamous cell carcinoma of the esophagus. This suggests that gastric surgery and its associated duodenogastroesophageal reflux do not play a role in the etiology and rising incidence of adenocarcinoma of the esophagus. White males in their mid-60s with Barrett's esophagus who smoke and drink alcohol are at highest risk for adenocarcinoma of the esophagus.