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.
| Original language | English |
|---|---|
| Pages (from-to) | 1683-1691 |
| Number of pages | 9 |
| Journal | Journal of Gastrointestinal Surgery |
| Volume | 20 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - Oct 2016 |
Keywords
- Bariatric surgery
- Obesity
- Oesophageal neoplasms
- Treatment outcome
Cite this
}
Diagnosis and Management of Oesophageal Cancer in Bariatric Surgical Patients. / Burton, Paul R.; Ooi, Geraldine J.; Laurie, Cheryl; Shaw, Kalai; O'Brien, Paul E.; Smith, Andrew; Nottle, Peter D.; Brown, Wendy A.
In: Journal of Gastrointestinal Surgery, Vol. 20, No. 10, 10.2016, p. 1683-1691.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Diagnosis and Management of Oesophageal Cancer in Bariatric Surgical Patients
AU - Burton, Paul R.
AU - Ooi, Geraldine J.
AU - Laurie, Cheryl
AU - Shaw, Kalai
AU - O'Brien, Paul E.
AU - Smith, Andrew
AU - Nottle, Peter D.
AU - Brown, Wendy A.
PY - 2016/10
Y1 - 2016/10
N2 - 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.
AB - 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.
KW - Bariatric surgery
KW - Obesity
KW - Oesophageal neoplasms
KW - Treatment outcome
UR - http://www.scopus.com/inward/record.url?scp=84982946391&partnerID=8YFLogxK
U2 - 10.1007/s11605-016-3221-0
DO - 10.1007/s11605-016-3221-0
M3 - Article
VL - 20
SP - 1683
EP - 1691
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
SN - 1091-255X
IS - 10
ER -