Minimally invasive esophagectomy is safe in patients with previous gastric bypass

Rossidis, Georgios; Browning, Robert; Hochwald, Steven N.; Abbas, Husain; Kim, Tad; Ben-David, Kfır

doi:10.1016/j.soard.2013.03.015

Cited by 17 publications

(6 citation statements)

References 19 publications

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“…Since the gastric remnant is usually preserved at the greater curvature during these procedures and both the right gastric artery and the right gastroepiploic artery are routinely untouched [32]. Colonic interposition or high esophagojejunostomy offer an alternative for restoring continuity and the patient should be counseled and prepared for this possibility [33]. The presented cohort shows a great variety in type of bariatric surgery, disease type (EAC, SCC, and Barret's esophagus), cancer location, cancer stage, and time interval between bariatric surgery and cancer diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Approximately half of the available evidence has been published within the past 2 years, illustrating a recent growth in interest [12,[36][37][38][39][40]. The literature mainly involves small case series, none of which included more than eight patients, which describe similar treatment options [15,16,33,[41][42][43]. The majority of curative treatment options comprise esophagectomy followed by gastric conduit formation after Roux-en-Y gastric bypass or, for junction tumors total gastrectomy with distal esophagectomy followed by esophagojejunostomy, a treatment option that was not performed in any of the patients in current cohort [37].…”

Section: Discussionmentioning

confidence: 99%

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Esophageal Cancer After Bariatric Surgery: Increasing Prevalence and Treatment Strategies

et al. 2021

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Purpose The number of bariatric procedures has increased exponentially over the last 20 years. On the background of ever-increasing incidence of esophageal malignancies, the altered anatomy after bariatric surgery poses challenges in treatment of these cancers. In this study, an epidemiological estimate is presented for the future magnitude of this problem and treatment options are described in a retrospective multicenter cohort. Methods The number of bariatric procedures, esophageal cancer incidence, and mortality rates of the general population were used for epidemiological estimates. A retrospective multicenter cohort was composed; patients were treated in three large oncological centers with a high upper gastrointestinal cancer caseload. Consecutive patients with preceding bariatric surgery who developed esophageal cancer between 2014 and 2019 were included. Results Approximately 3200 out of 6.4 million post bariatric surgery patients are estimated to have developed esophageal cancer between 1998 and 2018 worldwide. In a multicenter cohort, 15 patients with esophageal cancer or Barrett’s esophagus and preceding bariatric surgery were identified. The majority of patients had a history of Roux-en-Y gastric bypass (46.7%) and had an adenocarcinoma of the distal esophagus (60%). Seven patients received curative surgical treatment, five of whom are still alive at last follow-up (median follow-up 2 years, no loss to follow-up). Conclusion Based on worldwide data, esophageal cancer development following bariatric surgery has increased over the past decades. Treatment of patients with esophageal cancer after bariatric surgery is challenging and requires a highly individualized approach in which optimal treatment and anatomical limitations are carefully balanced. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Esophageal Cancer After Bariatric Surgery: Increasing Prevalence and Treatment Strategies

et al. 2021

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“…Weight loss and relief of reflux could be the main contributing factors that help in preventing the development of BE or its progression. However, others have reported the occurrence of tumor transformation after RYGB [14]. The reduction in the gastrointestinal tract motility due to gastric manipulation during the operation, the increase in the transit time of gastric acid within the gastric pouch, the proximity of the pouch to the distal esophagus, or the raised intragastric pressure in the small pouch may all play a role in the transformation process that occurred in these cases.…”

Section: Discussionmentioning

confidence: 99%

High grade dysplasia or esophageal adenocarcinoma in patients with a history of Roux-en-Y gastric bypass surgery: a case series

et al. 2020

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Background Roux-en-Y gastric bypass (RYGB) is the favored bariatric option in patients with gastroesophageal reflux and Barrett’s esophagus because it prevents reflux. Weight loss and decreased reflux following RYGB could theoretically minimize the risk of progression to cancer. We aimed to demonstrate the management of high grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) developing in patients after RYGB. Methods A prospectively maintained database was searched to identify cases of HGD and cancer in RYGB patients. Charts were reviewed for past history, endoscopic findings, endoscopic therapy, and pathology findings. Results There were five cases where HGD/EAC developed several years after RYGB. The prior bariatric surgery precluded curative esophagectomy, illustrating the management challenges. All but one of the patients were uniquely and successfully managed with endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Conclusions RYGB patients are still at risk of developing esophageal cancer. Patients at risk should be screened prior to RYGB and those with Barret’s esophagus need to undergo rigorous endoscopic surveillance following surgery. If detected early, EMR and ESD are invaluable in managing those who progress.

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“…2,3 Bariatric surgical procedures remain a challenge during the surgical treatment of esophageal cancer, and the remnant stomach is rarely usable as a future conduit. [4][5][6][7][8] Laparoscopic sleeve gastrectomy is the most popular and performed procedure amongst weight-loss operations. 9 The vascular supply of the remaining gastric tube following sleeve gastrectomy lies on the left and right gastric arteries along the lesser curvature, rending the gastric tube unusable as a conduit for esophageal reconstruction.…”

Section: History Of Prior Surgerymentioning

confidence: 99%

Graft and preparation issues during esophageal reconstruction

Boukerrouche¹

2020

GHOA

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Minimally invasive esophagectomy is safe in patients with previous gastric bypass

Cited by 17 publications

References 19 publications

Esophageal Cancer After Bariatric Surgery: Increasing Prevalence and Treatment Strategies

Esophageal Cancer After Bariatric Surgery: Increasing Prevalence and Treatment Strategies

High grade dysplasia or esophageal adenocarcinoma in patients with a history of Roux-en-Y gastric bypass surgery: a case series

Graft and preparation issues during esophageal reconstruction

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