Pancreatoduodenectomy after Roux-en-Y gastric bypass: technical considerations and outcomes

Peng, June S.; Corcelles, Ricard; Choong, Kevin K. L.; Poturalski, Matthew; Gandhi, Namita; Walsh, R. Matthew; Hardacre, Jeffrey M.; Brethauer, Stacy A.; Morris‐Stiff, Gareth

doi:10.1016/j.hpb.2017.08.015

Cited by 10 publications

(12 citation statements)

References 20 publications

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“…Although the incidence cholangiocarcinoma post bariatric surgery appeared low, the three reported cases of cholangiocarcinoma were diagnosed at an advanced stage (Beghdadi, 2020). Cases by Tumour Type 3,[24][25][26][27][28]31 of the 24 cases. These were distributed as follow; Pain (4), Pain and Jaundice (3), Jaundice and Weight loss (1), Jaundice (1), and Incidental finding (4).…”

Section: Cholangiocarcinomamentioning

confidence: 97%

“…The review found 11 authors that reported pancreatic and cholangiocarcinoma with total 27 reported cases 3,19,[22][23][24][25][26][27][28][29][30][31] .…”

Section: Reported Cases Post Bariatric Surgerymentioning

confidence: 99%

“…With regards to surgical management of the pancreatic cancer, majority of authors reported the option of gastrectomy of the remnant stomach and when not feasible gastrostomy was the option of choice. The remnant stomach was spared in six cases where pancreaticoduodenectomy with other with reconstruction was performed 3,24,[26][27][28]31 .…”

Section: Cholangiocarcinomamentioning

confidence: 99%

“…Pancreatic cancer is usually diagnosed late where 85% of cases are inoperable due to distant metastases indicating a poor prognosis with less overall survival rate. Previous Gastric or Bariatric surgery presents a diagnostic and management challenge for the treating surgeon 3 . Recent observation found that there is a shift in the epidemiology of certain cancers where they are happening more in younger patient that previously known i.e >50 years 4 .…”

Section: Introductionmentioning

confidence: 99%

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Obesity and Biliopancreatic Cancers: Exploring Current Evidence

Al-Saadi¹,

Gi²

2021

RAJAR

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Background: Pancreatic cancer (PC) is among foremost causes of cancer related deaths worldwide due to generic symptoms and lack of screening. The risk of developing pancreatic cancer in obese or overweight individuals is 1.5 times higher than individuals with a normal BMI. Bariatric Surgery has been associated with a reduction of obesity- related cancer, however, the number of cases that developed pancreatic cancer post Bariatric surgery is not known. Aim: Examine the relationship between Bariatric Surgery and Pancreatic cancer and identify reported cases of pancreatic cancer after bariatric surgery. Materials and Methods: A narrative review of the literature was conducted. A MEDLINE database search was performed using the following Medical Subject Headings (MeSH) terms: pancreatic cancer, bariatric surgery, weight reduction surgery, pancreatic adenocarcinoma. These were combined with the following: postoperative, after surgery, and during surgery. A WebScience search was then performed using similar terms. Additional references were then identified by manual search of the articles obtained from the MEDLINE and Web of Science. Cancer cases that were identified at the pre-operative period or intra-operatively were excluded. The searches covered the period from January 2000 to November 2020. Results/Review: Epidemiological evidence has shown that obesity as a risk factor for the development of PC is a dose dependent risk. The review found that the risk of developing pancreatic cancer in obese or overweight individuals is 1.5 times higher than individuals with a normal BMI. At the same time, evidence from literature demonstrated that weight reduction by dietary restriction, physical activities, pharmacotherapy or weight reduction surgery reduces risk of PDAC. A total of 24 cases of pancreatic cancer were identified and reported post Bariatric Surgery in the literature. The average age at diagnosis was 57.2 years and onset from surgery to diagnosis ranged from 2 months to 25 years. Of the identified cases, 23 cases were post Roux-en-Y Gastric Bypass and one case post Duodenal Switch. The review found that PDAC was the commonest reported pancreatic cancer post bariatric surgery accounting for 58.3%, followed by Neuroendocrine Tumours (NET) 16.7%. Conclusions: Along with weight reduction and improving comorbidities, Bariatric surgery reduces risk of obesity-related carcinogenesis. Given the variation in onset of diagnosis, bariatric surgery did not increase cancer risk but rather accelerated the diagnosis of pancreatic cancer.

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Section: Cholangiocarcinomamentioning

confidence: 97%

“…The review found 11 authors that reported pancreatic and cholangiocarcinoma with total 27 reported cases 3,19,[22][23][24][25][26][27][28][29][30][31] .…”

Section: Reported Cases Post Bariatric Surgerymentioning

confidence: 99%

Section: Cholangiocarcinomamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Obesity and Biliopancreatic Cancers: Exploring Current Evidence

Al-Saadi¹,

Gi²

2021

RAJAR

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“…Several studies describe the operative experience for pancreatic adenocarcinoma or biliary strictures in these patients, with fate of the remnant gastrectomy and management of the biliopancreatic limb being key considerations. [30][31][32][33] Given the long duration between RYGB and symptom development, more RYGB patients will likely be referred to hepatobiliary centers for management of benign and malignant biliary disease in the coming years, despite the decreasing frequency of RYGB being performed for morbid obesity.…”

Section: Access Techniques and Outcomesmentioning

confidence: 99%

Ampullary stenosis and choledocholithiasis post Roux-En-Y gastric bypass: challenges of biliary access and intervention

Wisneski

Carter

Nakakura

et al. 2020

HPB

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Background: Ampullary stenosis following Roux-en-Y gastric bypass (RYGB) is increasingly encountered. We describe cases of biliary obstruction from ampullary stenosis and choledocholithiasis to illustrate the associated diagnostic and interventional challenges with this condition.Methods: We reviewed medical records of patients with prior RYGB who underwent a biliary access procedure or surgery for non-malignant disease from January 2012-December 2018.Results: We identified 15 patients (4 male, 11 female; mean age 53.7 years) who had RYGB on average 11.7 years (range 1-32) years before diagnosis of biliary obstruction. Fourteen patients reported abdominal pain, 5 had nausea/emesis, 12 had elevated liver function tests, and 6 had ascending cholangitis. Mean common bile duct (CBD) diameter at presentation was 16.9 mm (range 4.0-25.0 mm).Operations included 3 transduodenal ampullectomies (2 with biliary bypass), 2 CBD explorations with stone extraction, 1 laparoscopic cholecystectomy alone, 1 Whipple procedure, 1 balloon enteroscopy with sphincterotomy, and 7 transgastric endoscopic retrograde cholangiopancreatography. All ampulla pathology was benign in patients who underwent resection. At follow-up (mean 15.4 months; range 0.23-44.5 months), 12/15 (80%) reported symptom resolution or improvement. Discussion: Ampullary stenosis after RYGB presents challenges for diagnostic evaluation and intervention, often requiring multi-disciplinary expertise. The underlying pathology remains to be elucidated.

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Surgical Outcome of Pancreaticoduodenectomy in Patients with a History of Roux‐en‐Y Reconstruction after Tumor Removal

et al. 2021

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Background The need for pancreaticoduodenectomy (PD) after Roux‐en‐Y (RY) reconstruction after tumor removal is expected to increase in future, but current studies on outcome are sparse. This surgery is challenging, due to intraabdominal adhesions and/or anatomical changes introduced by the previous abdominal surgery. Here, we investigated the surgical outcomes of PD after RY reconstruction following tumor removal. Methods We enrolled 283 patients that underwent PD. Surgical outcomes for PD were compared between patients with or without a history of RY reconstruction after tumor removal. Outcomes were also compared between two different surgical procedures for the post‐PD reconstruction. Results Among 283 patients, 11 had a history of RY reconstruction after tumor removal (3.9%). Among these, RY reconstructions had been performed where the small intestine was anastomosed to a remnant stomach after distal gastrectomy (n = 2), to remnant stomach after proximal gastrectomy (n = 1), to the esophagus after total gastrectomy (n = 6), or to the hepatic duct after extrahepatic bile duct resection (n = 2). Surgical outcomes were not significantly different between cases with and without RY reconstructions. We identified two different reconstruction procedures after removing the periampullary tumor during PD. The surgical outcomes were not significantly different between these two reconstruction groups. Conclusions The surgical outcome of PD was not significantly affected by a history of RY reconstruction. Similarly, the type of reconstruction performed during PD did not significantly affect the outcome. These results could be useful when planning PD in patients with a history of RY reconstruction after tumor removal.

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Pancreatoduodenectomy after Roux-en-Y gastric bypass: technical considerations and outcomes

Abstract: Pancreatic surgeons will see an increasing number of patients with Roux-en-Y anatomy who will require evaluation and resection for periampullary diseases. For PD after RYGB, we recommend remnant gastrectomy with reconstruction using the BP limb.

Cited by 10 publications

References 20 publications

Obesity and Biliopancreatic Cancers: Exploring Current Evidence

Obesity and Biliopancreatic Cancers: Exploring Current Evidence

Ampullary stenosis and choledocholithiasis post Roux-En-Y gastric bypass: challenges of biliary access and intervention

Surgical Outcome of Pancreaticoduodenectomy in Patients with a History of Roux‐en‐Y Reconstruction after Tumor Removal

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