Paul R Burton1,2, Geraldine J Ooi3,4, Cheryl Laurie4, Kalai Shaw3, Paul E O'Brien3,4, Andrew Smith3, Peter D Nottle3, Wendy A Brown3,4. 1. Upper Gastrointestinal Surgical Unit, The Alfred Hospital, 99 Commercial Rd, Prahran, 3181, Australia. paul.burton@monash.edu. 2. Centre for Obesity Research and Education (CORE), Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Prahran, 3181, Australia. paul.burton@monash.edu. 3. Upper Gastrointestinal Surgical Unit, The Alfred Hospital, 99 Commercial Rd, Prahran, 3181, Australia. 4. Centre for Obesity Research and Education (CORE), Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Prahran, 3181, Australia.
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.
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 obesepatients and the specific effects of previous bariatric procedures need to be understood, particularly the limitations on reconstructive options.
Authors: David C Whiteman; Mark Appleyard; Farzan F Bahin; Yuri V Bobryshev; Michael J Bourke; Ian Brown; Adrian Chung; Andrew Clouston; Emma Dickins; Jon Emery; Guy D Eslick; Louisa G Gordon; Florian Grimpen; Geoff Hebbard; Laura Holliday; Luke F Hourigan; Bradley J Kendall; Eric Yt Lee; Angelique Levert-Mignon; Reginald V Lord; Sarah J Lord; Derek Maule; Alan Moss; Ian Norton; Ian Olver; Darren Pavey; Spiro Raftopoulos; Shan Rajendra; Mark Schoeman; Rajvinder Singh; Freddy Sitas; B Mark Smithers; Andrew C Taylor; Melissa L Thomas; Iain Thomson; Henry To; Jutta von Dincklage; Christine Vuletich; David I Watson; Ian F Yusoff Journal: J Gastroenterol Hepatol Date: 2015-05 Impact factor: 4.029
Authors: Wendy A Brown; Julia Moszkowicz; Leah Brennan; Paul R Burton; Margaret Anderson; Paul E O'Brien Journal: Obes Surg Date: 2013-10 Impact factor: 4.129
Authors: Mario Musella; Giovanna Berardi; Alessio Bocchetti; Roberta Green; Valeria Cantoni; Nunzio Velotti; Katia Di Lauro; Domenico Manzolillo; Antonio Vitiello; Marco Milone; Giovanni Domenico De Palma Journal: Obes Surg Date: 2019-08 Impact factor: 4.129
Authors: Richard Y Chen; Paul R Burton; Geraldine J Ooi; Cheryl Laurie; Andrew I Smith; Gary Crosthwaite; Paul E O'Brien; Geoff Hebbard; Peter D Nottle; Wendy A Brown Journal: Obes Surg Date: 2017-09 Impact factor: 4.129