Top

Published in:

01-10-2016 | Original Article

Diagnosis and Management of Oesophageal Cancer in Bariatric Surgical Patients

Authors: Paul R. Burton, Geraldine J. Ooi, Cheryl Laurie, Kalai Shaw, Paul E. O’Brien, Andrew Smith, Peter D. Nottle, Wendy A. Brown

Published in: Journal of Gastrointestinal Surgery | Issue 10/2016

Abstract

Background

Oesophageal cancer following bariatric surgery adds significant complexity to an already challenging disease. There is limited data on the diagnosis, presentation and management in these complex cases.

Methods

A retrospective cohort study on prospectively collected data over 10 years was conducted. The oesophago-gastric cancer database was searched for patients with prior bariatric surgery. Data were retrieved on bariatric and cancer management.

Results

We identified nine patients with oesophageal or gastro-oesophageal junction adenocarcinoma after bariatric surgery. Mean age was 58.3 ± 6.9 years, and duration from bariatric surgery was 13.2 ± 9.4 years. Weight loss at diagnosis was 30.6 ± 23.3 kg (excess weight loss 58.1 % ± 29.6). Modes of presentation were Barrett’s surveillance (n = 3), reflux symptoms (n = 4) and incidental (n = 2). Management was surgical resection (n = 4), endoscopic mucosal resection (n = 2) and palliative (n = 3). Surgical resections were challenging due to adhesions, obesity, luminal dilatation and scarring on the stomach. There were two substantial leaks following gastroplasty.

Conclusions

Oesophageal cancer following bariatric surgery is a challenging problem, and surgical resection carries high risk. A high index of suspicion is required and symptoms investigated precipitously. Technical challenges of operating on obese patients and the specific effects of previous bariatric procedures need to be understood, particularly the limitations on reconstructive options.

Rubenstein, JH and Shaheen, NJ. Epidemiology, Diagnosis, and Management of Esophageal Adenocarcinoma. Gastroenterology, 2015. 149(2): 302–17 e1.

Pennathur, A, Gibson, MK, Jobe, BA, and Luketich, JD. Oesophageal carcinoma. Lancet, 2013. 381(9864): 400–12.

Byers, T and Sedjo, RL. Body fatness as a cause of cancer: epidemiologic clues to biologic mechanisms. Endocr Relat Cancer, 2015. 22(3): R125-34.

Scozzari, G, Trapani, R, Toppino, M, and Morino, M. Esophagogastric cancer after bariatric surgery: systematic review of the literature. Surg Obes Relat Dis, 2013. 9(1): 133–42.

Cunningham, D, Allum, WH, Stenning, SP, Thompson, JN, Van de Velde, CJ, Nicolson, M, Scarffe, JH, Lofts, FJ, Falk, SJ, Iveson, TJ, Smith, DB, Langley, RE, Verma, M, Weeden, S, and Chua, YJ. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med, 2006. 355(1): 11–20.

Cichowitz, A, Burton, P, Brown, W, Smith, A, Shaw, K, Slamowicz, R, and Nottle, PD. Ex vivo dissection increases lymph node yield in oesophagogastric cancer. ANZ J Surg. 2015;85(1–2):80–84.

Tarnoff M, Kaplan LM, Shikora S. An evidence-based assessment of pre-operative weight loss in bariatric surgery. Obes Surg. 2008; 18:1059–61.

Ross R, Rissanen J, Pedwell H, Clifford J, Shragge P. Influence of diet and exercise on skeletal muscle and visceral adipose tissue in men. J Appl Physiol. 1996;81:2445–2455.

Colles SL, Dixon JB, Marks P, Strauss BJ, O’Brien PE. Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006;84(2):304–311.

10.

Brown WA, Moszkowicz J, Brennan L, Burton PR, Anderson M, O’Brien PE. Pre-operative weight loss does not predict weight loss following laparoscopic adjustable gastric banding. Obes Surg. 2013;23:1611–1615.

11.

Medicare. https://www.medicareaustralia.gov.au/statistics/mbs_group.shtml. 2014.

12.

Sharaf, RN, Weinshel, EH, Bini, EJ, Rosenberg, J, Sherman, A, and Ren, CJ. Endoscopy plays an important preoperative role in bariatric surgery. Obes Surg, 2004. 14(10): 1367–72.

13.

Loewen, M, Giovanni, J, and Barba, C. Screening endoscopy before bariatric surgery: A series of 448 patients. Surg Obes Relat Dis, 2008. 4(6): 709–12.

14.

Whiteman, DC, Appleyard, M, Bahin, FF, Bobryshev, YV, Bourke, MJ, Brown, I, Chung, A, Clouston, A, Dickins, E, Emery, J, Eslick, GD, Gordon, LG, Grimpen, F, Hebbard, G, Holliday, L, Hourigan, LF, Kendall, BJ, Lee, EY, Levert-Mignon, A, Lord, RV, Lord, SJ, Maule, D, Moss, A, Norton, I, Olver, I, Pavey, D, Raftopoulos, S, Rajendra, S, Schoeman, M, Singh, R, Sitas, F, Smithers, BM, Taylor, AC, Thomas, ML, Thomson, I, To, H, von Dincklage, J, Vuletich, C, Watson, DI, and Yusoff, IF. Australian clinical practice guidelines for the diagnosis and management of Barrett’s esophagus and early esophageal adenocarcinoma. J Gastroenterol Hepatol, 2015. 30(5): 804–20.

15.

Coe, PO, O’Reilly, DA, and Renehan, AG. Excess adiposity and gastrointestinal cancer. Br J Surg, 2014. 101(12): 1518–31.

16.

De Pergola, G and Silvestris, F. Obesity as a major risk factor for cancer. J Obes, 2013. 2013: 291546.

17.

Chiba, T, Marusawa, H, and Ushijima, T. Inflammation-associated cancer development in digestive organs: mechanisms and roles for genetic and epigenetic modulation. Gastroenterology, 2012. 143(3): 550–63.

18.

Aleman, JO, Eusebi, LH, Ricciardiello, L, Patidar, K, Sanyal, AJ, and Holt, PR. Mechanisms of obesity-induced gastrointestinal neoplasia. Gastroenterology, 2014. 146(2): 357–73.

19.

Birks, S, Peeters, A, Backholer, K, O’Brien, P, and Brown, W. A systematic review of the impact of weight loss on cancer incidence and mortality. Obes Rev, 2012. 13(10): 868–91.

20.

Peeters, A, O’Brien, PE, Laurie, C, Anderson, M, Wolfe, R, Flum, D, MacInnis, RJ, English, DR, and Dixon, J. Substantial intentional weight loss and mortality in the severely obese. Ann Surg, 2007. 246(6): 1028–33.

21.

Yang, XW, Li, PZ, Zhu, LY, and Zhu, S. Effects of bariatric surgery on incidence of obesity-related cancers: a meta-analysis. Med Sci Monit, 2015. 21: 1350–7.

22.

Australian Institute of Health and Welfare, Australasian Association of Cancer Registries, Cancer in Australia: An overview, 2012, in Cancer series no. 74. 2012: Canberra: AIHW.

Title: Diagnosis and Management of Oesophageal Cancer in Bariatric Surgical Patients
Authors: Paul R. Burton
Geraldine J. Ooi
Cheryl Laurie
Kalai Shaw
Paul E. O’Brien
Andrew Smith
Peter D. Nottle
Wendy A. Brown
Publication date: 01-10-2016
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 10/2016
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-016-3221-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Diagnosis and Management of Oesophageal Cancer in Bariatric Surgical Patients

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2016

Technical Details of an Anterior Approach to the Superior Mesenteric Artery During Pancreaticoduodenectomy

Does Diverting Loop Ileostomy Improve Outcomes Following Open Ileo-Colic Anastomoses? A Nationwide Analysis

Water-Soluble Enema Prior to Ileostomy Closure in Patients Undergoing Low Anterior Resection: Is It Necessary?

Importance of esophageal manometry and pH monitoring for the evaluation of otorhinolaryngologic (ENT) manifestations of GERD. A multicenter study

Abdominal Wall Schwannoma

Inhaled Beta Agonist Bronchodilator Does Not Affect Trans-diaphragmatic Pressure Gradient but Decreases Lower Esophageal Sphincter Retention Pressure in Patients with Chronic Obstructive Pulmonary Disease (COPD) and Gastroesophageal Reflux Disease (GERD)