Early Gastric Cancer found at Preoperative Assessment for Bariatric Surgery

Abstract

An association between gastric cancer and obesity has been suggested in large epidemiologic series. We present a 61-year-old lady with BMI 48.7 kg/m2, who underwent preoperative work-up for Roux-en-Y gastric bypass. Her endoscopy showed a depressed lesion at the incisura angularis, suggesting early gastric cancer. The biopsy confirmed well/moderately-differentiated adenocarcinoma. The surgical approach was subtotal gastrectomy leaving only part of the fundus, and was performed on an oncological basis, with lymphatic D2 dissection. The gastro-enterostomy was 1.5 cm wide, and was constructed closer to the greater curvature over a 12-Fr Fouchet tube. The reconstruction was in a Roux-en-Y fashion, but the alimentary limb was 150 cm long. Despite the short follow-up, the way the surgery was conducted presumably maintained both oncologic and bariatric determinations.

Importance of Routine Preoperative Upper GI Endoscopy: Why All Patients Should Be Evaluated?

“…Different studies report gastric cancer after bariatric surgery, but only a few report this as a BMI Body mass index preoperative finding. Seva-Pereira et al [26] and Boru et al [27] had previously reported one case of early gastric cancer during preoperative assessment for bariatric surgery. Barrett's esophagus has also been reported in previous studies; Boru et al [27] confirm Barrett's esophagus in one female patient (0.16%), Zeni et al [25] report two patients (1.3%) with Barrett's esophagus in a cohort of 159 patients, neither of whom had dysplasia, and Azagury et al [19] found one patient (0.6%).…”

Gastric Cancer After Laparoscopic Adjustable Gastric Banding

“…In Europe, gastric banding is the most frequently performed bariatric operation. The risk of esophageal and gastric cancer, especially after restrictive procedures, has only been reported in case reports and in one review [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

Diagnostic Yield and Clinical Implications of Preoperative Upper Gastrointestinal Endoscopy in Morbidly Obese Patients Undergoing Bariatric Surgery

“…15 Malignancy may be uncommon but if suspected needs additional evaluation. 16 Performance of a sleeve gastrectomy in the presence of a hiatal hernia and/or gastroesophageal reflux is controversial. Some studies have reported exacerbation of gastroesophageal reflux disease in some or de novo reflux in others, whereas some have reported not much influence on gastroesophageal reflux disease.…”