Chetan Parmar1, Roxanna Zakeri2, Mohamed Abouelazayem3, Thomas H Shin4, Ali Aminian4, Tala Mahmoud5, Barham K Abu Dayyeh5, Melissa Y Wee6, Laura Fischer7, Freek Daams8, Kamal Mahawar9. 1. Department of Surgery, Whittington Health NHS Trust, London, UK. Electronic address: drcparmar@gmail.com. 2. Department of Surgery, Whittington Health NHS Trust, London, UK; Centre for Obesity Research, University College, London, UK. 3. Department of Surgery, St George's University Hospitals NHS Foundation Trust, London, UK. 4. Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio. 5. Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota. 6. Department of Oesophagogastric Surgery, Flinders Medical Centre, Adelaide, Australia. 7. Department of Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma. 8. Department of Surgery, Amsterdam UMC, VUmc, Amsterdam, The Netherlands. 9. Department of Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK.
Abstract
BACKGROUND: Bariatric surgery can influence the presentation, diagnosis, and management of gastrointestinal cancers. Esophagogastric (EG) malignancies in patients who have had a prior bariatric procedure have not been fully characterized. OBJECTIVE: To characterize EG malignancies after bariatric procedures. SETTING: University Hospital, United Kingdom. METHODS: We performed a retrospective, multicenter observational study of patients with EG malignancies after bariatric surgery to characterize this condition. RESULTS: This study includes 170 patients from 75 centers in 25 countries who underwent bariatric procedures between 1985 and 2020. At the time of the bariatric procedure, the mean age was 50.2 ± 10 years, and the mean weight 128.8 ± 28.9 kg. Women composed 57.3% (n = 98) of the population. Most (n = 64) patients underwent a Roux-en-Y gastric bypass (RYGB) followed by adjustable gastric band (AGB; n = 46) and sleeve gastrectomy (SG; n = 43). Time to cancer diagnosis after bariatric surgery was 9.5 ± 7.4 years, and mean weight at diagnosis was 87.4 ± 21.9 kg. The time lag was 5.9 ± 4.1 years after SG compared to 9.4 ± 7.1 years after RYGB and 10.5 ± 5.7 years after AGB. One third of patients presented with metastatic disease. The majority of tumors were adenocarcinoma (82.9%). Approximately 1 in 5 patients underwent palliative treatment from the outset. Time from diagnosis to mortality was under 1 year for most patients who died over the intervening period. CONCLUSION: The Oesophago-Gastric Malignancies After Obesity/Bariatric Surgery study presents the largest series to date of patients developing EG malignancies after bariatric surgery and attempts to characterize this condition.
BACKGROUND: Bariatric surgery can influence the presentation, diagnosis, and management of gastrointestinal cancers. Esophagogastric (EG) malignancies in patients who have had a prior bariatric procedure have not been fully characterized. OBJECTIVE: To characterize EG malignancies after bariatric procedures. SETTING: University Hospital, United Kingdom. METHODS: We performed a retrospective, multicenter observational study of patients with EG malignancies after bariatric surgery to characterize this condition. RESULTS: This study includes 170 patients from 75 centers in 25 countries who underwent bariatric procedures between 1985 and 2020. At the time of the bariatric procedure, the mean age was 50.2 ± 10 years, and the mean weight 128.8 ± 28.9 kg. Women composed 57.3% (n = 98) of the population. Most (n = 64) patients underwent a Roux-en-Y gastric bypass (RYGB) followed by adjustable gastric band (AGB; n = 46) and sleeve gastrectomy (SG; n = 43). Time to cancer diagnosis after bariatric surgery was 9.5 ± 7.4 years, and mean weight at diagnosis was 87.4 ± 21.9 kg. The time lag was 5.9 ± 4.1 years after SG compared to 9.4 ± 7.1 years after RYGB and 10.5 ± 5.7 years after AGB. One third of patients presented with metastatic disease. The majority of tumors were adenocarcinoma (82.9%). Approximately 1 in 5 patients underwent palliative treatment from the outset. Time from diagnosis to mortality was under 1 year for most patients who died over the intervening period. CONCLUSION: The Oesophago-Gastric Malignancies After Obesity/Bariatric Surgery study presents the largest series to date of patients developing EG malignancies after bariatric surgery and attempts to characterize this condition.