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To examine the claim that life expectancy is reduced after curative peptic-ulcer surgery, we studied mortality and its causes in 779 men with peptic ulcer treated surgically between 1947 and 1965. The minimum follow-up period of survivors was 15 years. There was an excess mortality in the three major age groups (30 to 39, 40 to 49, and 50 to 59 years at operation), as compared with the general population (P less than 0.001), with a mean shift of 9.1 years in the survival curve. Surgery was not the direct cause of death. In particular, the eight deaths from carcinoma of the stomach were no more than expected. Excess mortality was due to smoking-associated disease, which accounted for 200 deaths. Eighty-three per cent of the patients were cigarette smokers. We conclude that substituting highly selective vagotomy for gastrectomy will not lead to improved survival, because 80 per cent of patients now having operations for ulcer are heavy cigarette smokers.
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