Benign, Premalignant, and Malignant Lesions Encountered in Bariatric Surgery

Abstract

A bariatric surgeon needs to be aware of the possibility of benign tumors and cancer in obese patients as well as the optimal management of these conditions that may be present at the time of evaluation for bariatric surgery.

Postoperative finding of gastric neuroendocrine tumor in a patient undergoing a mini gastric bypass: points to consider

“…Further testing should be done to look for associated diseases such as Biermer's disease or Zollinger-Ellison syndrome with multiple endocrine neoplasia type I (MEN I) by assaying blood levels of glucose, gastrin, serotonin, and urinary methoxylated derivatives. CT scan of the thorax and abdomen and Octreoscan (to image tumors with somatostatin receptors that bind octreotide) should be done to assess tumor extension [4]. In our patients, these imaging studies were negative.…”

“…There is no correlation between the endoscopic appearance of the gastric mucosa and the histologic appearance. Gastritis is diagnosed solely based on pathology findings, which is why biopsies should be routinely performed during preoperative gastroscopy before bariatric surgery [4].…”

Laparoscopic transhiatal esophagectomy for esophageal adenocarcinoma identified at laparoscopic Roux-en-Y gastric bypass

“…The incidence of cancer in BE has increased from 4 to 23 cases per million [13] . A BMI of ≥30 kg/m 2 increases the odds of having BE by 1.35 times [14] . It remains unclear if BMI is associated with progression of metaplasia to dysplasia or if the increased risk of BE is confounded by symptomatic GERD [14] .…”

Manejo de tumores gástricos del estroma gastrointestinal encontrados en cirugía bariátrica: un desafío quirúrgico

“…Según las guías del National Comprehensive Cancer Network (NCCN), en todo tumor gástrico del estroma gastrointestinal con menos de 50 mitosis por campo de mayor aumento y con un tamaño menor de 2 cm, el riesgo de progresión de la enfermedad es cero y, por lo tanto, no se requiere de tratamiento quirúrgico. Sin embargo, en las guías canadienses basadas en el estudio de Huang, et al, sobre recurrencia tumoral y riesgo de metástasis, en el cual el 10 % de los pacientes con tumores del estroma gastrointestinal clasificados como de muy bajo riesgo presentaron metástasis, se recomienda el manejo quirúrgico de entrada 24,26,27 . Es importante tener en cuenta que este tipo de tumores están subdiagnosticados, pues los menores de 2 cm pueden pasar desapercibidos para el cirujano durante la intervención.…”