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Rossella Cianci, MD; Jacopo Galli, MD; Stefania Agostino, MD; Francesco Bartolozzi, MD; Antonio Gasbarrini, MD; Giovanni Almadori, MD; Domenico D'Ugo, MD; Giovanni Gasbarrini, MD; Giovanni Cammarota, MD

Arch Surg. 2003;138:751-754.

Background  Duodenogastroesophageal reflux is common after total or partial gastrectomy. No data are available on the effect of duodenal reflux on the larynx.

Hypothesis  Premalignant or malignant changes occur more frequently among subjects with gastric surgery.

Design  Historical cohort study.

Setting  Outpatient setting for upper endoscopy.

Patients  Ninety-three subjects who had undergone gastric resection at least 5 years previously, and 93 matched dyspeptic individuals who did not undergo gastric surgery.

Intervention  Clinical histories of all patients were obtained and recorded. All subjects underwent an otolaryngologic evaluation.

Results  Of 93 patients with gastric resection, 7 patients had current or previous laryngeal malignancies or current precancerous mucosal changes. In the control group, 1 subject had a leukoplakia on the vocal cord. The adjusted odds ratio (having included sex, age, and alcohol [yes or no] and smoking [yes or no] history in the regression model) was 9.88 (95% confidence interval, 1.01-97.31; likelihood ratio ² = 28.77; P<.001). Furthermore, there was a significant increased prevalence of benign laryngeal lesions in patients with gastric resection vs the control group.

Conclusions  The risk of developing laryngeal malignancies is higher for patients with gastric resection. A periodic otolaryngologic evaluation in subjects with gastric surgery may contribute to early diagnosis of laryngeal disorders.

From the Departments of Internal Medicine and Gastroenterology (Drs Cianci, A. Gasbarrini, G. Gasbarrini, and Cammarota), Otorhinolaryngology (Drs Galli, Agostino, and Almadori), Hygiene (Dr Bartolozzi), and Surgery (Dr D'Ugo), Catholic University of Medicine and Surgery, Rome, Italy.

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Gastric Surgery as a Long-term Risk Factor for Malignant Lesions of the Larynx—Invited Critique
Marco G. Patti
Arch Surg. 2003;138(7):755.
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