Esophageal and gastric malignancies after bariatric surgery: a retrospective global study

Parmar, Chetan; Zakeri, Roxanna; Abouelazayem, Mohamed; Shin, Taehoon; Aminian, Ali; Mahmoud, Tala; Dayyeh, Barham K. Abu; Wee, Melissa; Fischer, Laura E.; Daams, Freek; Mahawar, Kamal

doi:10.1016/j.soard.2021.11.024

Cited by 21 publications

(4 citation statements)

References 17 publications

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“…When it came to preoperative considerations, the group of experts agreed with a significant consensus of 95.6% that EGD is necessary before any revision/conversion after SG and with 91.30% that MDT evaluation should be done in all revision/conversion procedures after SG. These agreements are concordant with primary bariatric surgery recommendations and with the actual IFSO position statement on the Role of Esophago-Gastro-Duodenal Endoscopy (2020), which recommend EGD routinely for all patients after SG at 1 year and then every 2-3 years, to enable early detection of Barrett's esophagus or upper GI malignancy until more data are available to confirm the incidence of these cancers in practice [11,12]. For this reason, it is self-evident that prior to any revision/conversion, especially for reflux symptoms, EGD is recommended by most of the consensus group.…”

Section: Preoperative Considerations About Conversion/ Revision After Sgsupporting

confidence: 61%

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Kermansaravi

Parmar

Chiappetta³

et al. 2023

Surg Endosc

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Background Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision. Methods Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus. Results Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redoprocedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD. Conclusion Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.

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Section: Preoperative Considerations About Conversion/ Revision After Sgsupporting

confidence: 61%

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Kermansaravi

Parmar

Chiappetta³

et al. 2023

Surg Endosc

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“…Conflicting data have been reported on the implications of bariatric surgery for the incidence of esophageal and gastric cancer . In 2017, a nationwide register-based cohort study from Sweden reported on the incidence of esophageal adenocarcinoma in 2 groups of patients with obesity: patients who received bariatric surgery and those who did not .…”

Section: Discussionmentioning

confidence: 99%

Risk of Esophageal and Gastric Cancer After Bariatric Surgery

et al. 2023

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ImportanceBariatric surgery has been associated with a reduced risk of cancer in individuals with obesity. The association of bariatric surgery with esophageal and gastric cancer is still controversial, however.ObjectiveTo compare the incidence of esophageal and gastric cancer between patients with obesity who underwent bariatric surgery and those who did not (control group).Design, Setting, and ParticipantsThis cohort study obtained data from a national discharge database, including all surgical centers, in France from January 1, 2010, to December 31, 2017. Participants included adults (aged ≥18 years) with severe obesity who underwent bariatric surgery (surgical group) or who did not (control group). Baseline characteristics were balanced between groups using nearest neighbor propensity score matching with a 1:2 ratio. The study was conducted from March 1, 2020, to June 30, 2021.ExposuresBariatric surgery (adjustable gastric banding, gastric bypass, and sleeve gastrectomy) vs no surgery.Main Outcomes and MeasuresThe main outcome was incidence of esophageal and gastric cancer. A secondary outcome was overall in-hospital mortality.ResultsA total of 303 709 patients who underwent bariatric surgery (245 819 females [80.9%]; mean [SD] age, 40.2 [11.9] years) were matched 1:2 with 605 140 patients who did not receive surgery (500 929 females [82.8%]; mean [SD] age, 40.4 [12.5] years). After matching, the 2 groups of patients were comparable in terms of age, sex, and comorbidities (standardized mean difference [SD], 0.05 [0.11]), with some differences in body mass index. The mean follow-up time was 5.62 (2.20) years in the control group and 6.06 (2.31) years in the surgical group. A total of 337 patients had esophagogastric cancer: 83 in the surgical group and 254 in the control group. The incidence rates were 6.9 per 100 000 population per year for the control group and 4.9 per 100 000 population per year for the surgical group, resulting in an incidence rate ratio of 1.42 (95% CI, 1.11-1.82; P = .005). The hazard ratio (HR) of cancer incidence was significantly in favor of the surgical group (HR, 0.76; 95% CI, 0.59-0.98; P = .03). Overall mortality was significantly lower in the surgical group (HR, 0.60; 95% CI, 0.56-0.64; P &lt; .001).Conclusions and RelevanceIn this large, nationwide cohort of patients with severe obesity, bariatric surgery was associated with a significant reduction of esophageal and gastric cancer incidence and overall in-hospital mortality, which suggests that bariatric surgery can be performed as treatment for severe obesity without increasing the risk of esophageal and gastric cancer.

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“…The study shows that almost one-third of patients presented with metastatic disease, and 85% of the tumors were adenocarcinoma [ 31 ]. In contrast, another recent cohort with more than 1 million patients in France showed a similar risk of developing colorectal cancer (CRC) among individuals with morbid obesity and the general population aged between 50 and 75 years [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Obesity-related cancer and bariatric surgery: A comprehensive systematic review and meta-analysis protocol

Feitosa,

de Souza Castro,

de Araújo

et al. 2024

PLoS ONE

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Introduction Obesity is a silent pandemic affecting all ages and is a component of metabolic syndrome. Its treatment is conducted by lifestyle and behavioral changes, pharmacological therapy, and when correctly indicated, bariatric surgery. In recent years, the procedures for weight loss have been investigated due to their relationship with the development of many types of cancer. Although many studies have shown that bariatric surgery decreases cancer risk, other researchers observed an increase in this association. Carcinogenesis is affected by many factors, such as age, sex, type of cancer, and the bariatric surgery performed on each patient. This systematic review and meta-analysis protocol aims to clarify the association between the different modalities of bariatric surgery and the risk of cancer development in adult patients with metabolic syndrome. Method and analysis The proposed systematic review and meta-analysis will be reported conforming to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) guidelines. This research will include observational studies (case-control and cohort studies) about patients who undergo bariatric surgery due to metabolic syndrome. Will be accepted in any language and any year. Publications without peer review will be excluded from this review. Data will be entered into the Review Manager software (RevMan5.2.3). We extracted or calculated the OR and 95% CI for dichotomous outcomes for each study. In case of heterogeneity (I2>50%), the random-effects model will combine the studies to calculate the OR and 95% CI. Ethics and dissemination This study will review the published data; Thus, obtaining ethical approval is unnecessary. The findings of this systematic review will be published in a peer-reviewed journal. Prospero registration number CRD42023432079.

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Esophageal and gastric malignancies after bariatric surgery: a retrospective global study

Cited by 21 publications

References 17 publications

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Risk of Esophageal and Gastric Cancer After Bariatric Surgery

Obesity-related cancer and bariatric surgery: A comprehensive systematic review and meta-analysis protocol

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