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Gastrectomy Is Not a Risk Factor for Pancreatic Cancer: a Meta-Analysis of Case-Control Studies
Rajan Kanth*1, Naga Swetha Samji1, Ramon E. Rivera2, Mainor R. Antillon2, Praveen K. Roy1
1Marshfield Clinic, Marshfield, WI; 2Gastroenterology, Ochsner Medical Center, Louisiana, LA
Introduction: Pancreatic cancer is common in the developed world. Several risk factors for pancreatic cancer have been identified. Recent studies have evaluated gastrectomy as a risk factor for pancreatic cancer. We conducted a meta-analysis of case-control studies to assess the role of gastrectomy as a risk factor for pancreatic cancer.
Methods: Pubmed, Embase, Web of Knowledge, reference lists of retrieved articles and conference abstracts were searched for relevant studies (Search date Sept 2013). Case control studies with gastrectomy for benign diseases were included. Gastrectomy for malignant conditions was excluded. Standardized forms were used to extract data. Data was extracted by two reviewers independently. Odds ratio was calculated using comprehensive Meta-analysis software. Newcastle-Ottawa Scale (NOS) was used to assess the quality of study. Heterogeneity was also assessed. Random effects model was used for pooling the data.
Results: Eleven case-control studies were included in this study (3951 cases/9609 control). Studies were reported from USA (6), Europe (4) and Taiwan (1). Seven studies included hospital based controls and 4 included population based controls. The sample sized ranged from 142 to 720 (cases) and 180 to 2098 (control). The age of the patients ranged from 20 - 79 yrs. The risk of pancreatic cancer was not increased in patients with prior history of gastrectomy (OR 1.39; 95% CI, 0.95 -2.03, p= 0.09). Subgroup analysis based on the geographical location revealed the risk was not increased in the USA (OR 1.65; 95% CI, 0.96-2.82, p=0.068) or Europe (OR 1.13; 95% CI 0.61-2.08, p=0.07). Subgroup analysis for Asia was not performed as there was only one study. Subgroup analysis based on the design of the study (population based control or hospital based controls) showed no significant difference. As per Newcastle-Ottawa Scale, nine studies were of high quality (7 or more NOS points) and two were of low quality (6 NOS points). Subgroup analysis based on quality did not show any significant difference. Moderate heterogeneity was present (I square =56%) and thus random effects model was used for analysis. Conclusion: A prior history of gastrectomy for benign gastric disorders is not associated with an increased risk for pancreatic cancer.
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