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: [email protected]
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a-00020 Dr. Robert RUTLEDGE
Title of Paper: RISK OF GASTRIC CANCER AFTER BILLROTH II IN THE MINI-GASTRIC BYPASS
Nationality: United States of AmericaPosition: Director
Department: SurgeryOrganization: Center For Laparoscopic Obesity Surgery
• 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 the earthworm Eisenia fetida. Tkalec M,
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
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.
Cellular neoplastic transformation induced by 916 MHz microwave radiation
Six Main Findings: #3Many Large Studies: No Increase Risk GCa after B2
• 3-Many Large Studies • No Increased Risk in GCa after B2.• E.G. Mayo Clinic Study
Six Main Findings: #4Some 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
Six Main Findings: #5Endoscopic 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 Endoscopicfollow up
• “Not Rewarding”
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
Six Main Findings: #6Surgeons 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)
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”
Danger of the Hot Dog!!!
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.
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
Danger of the Hot Dog!!!
• 50 g processed meat = Increased RR Gastric Cancer 2.5
• One Hot Dog = 50 g
CANCER QUIZ: MORE DEADLY CANCER CAUSING AGENT? A OR B
A B
Danger of the Hot Dog!!!
• One Hot Dog 50 g• Follow-up **6.5 yr**
• 50 g processed meat = Inc RR 2.5
• Billroth II • Follow up **30 yr**
• Inc RR 1.5
Survey 112 Bariatric Surgeons
• 89% Said:• Hot Dog was More Dangerous Billroth II
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)
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.
Fear Gastric Cancer?
• The Hot Dog more Dangerous than BII
Fear of Cell Phones?Fear of Gastric Cancer after B2?