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Diagnosis and Management of Oesophageal Cancer in Bariatric Surgical Patients

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Oesophageal cancer following bariatric surgery adds significant complexity to an already challenging disease. There is limited data on the diagnosis, presentation and management in these complex cases.

Methods

A retrospective cohort study on prospectively collected data over 10 years was conducted. The oesophago-gastric cancer database was searched for patients with prior bariatric surgery. Data were retrieved on bariatric and cancer management.

Results

We identified nine patients with oesophageal or gastro-oesophageal junction adenocarcinoma after bariatric surgery. Mean age was 58.3 ± 6.9 years, and duration from bariatric surgery was 13.2 ± 9.4 years. Weight loss at diagnosis was 30.6 ± 23.3 kg (excess weight loss 58.1 % ± 29.6). Modes of presentation were Barrett’s surveillance (n = 3), reflux symptoms (n = 4) and incidental (n = 2). Management was surgical resection (n = 4), endoscopic mucosal resection (n = 2) and palliative (n = 3). Surgical resections were challenging due to adhesions, obesity, luminal dilatation and scarring on the stomach. There were two substantial leaks following gastroplasty.

Conclusions

Oesophageal cancer following bariatric surgery is a challenging problem, and surgical resection carries high risk. A high index of suspicion is required and symptoms investigated precipitously. Technical challenges of operating on obese patients and the specific effects of previous bariatric procedures need to be understood, particularly the limitations on reconstructive options.

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Authors and Affiliations

  1. Upper Gastrointestinal Surgical Unit, The Alfred Hospital, 99 Commercial Rd, Prahran, 3181, Australia

    Paul R. Burton, Geraldine J. Ooi, Kalai Shaw, Paul E. O’Brien, Andrew Smith, Peter D. Nottle & Wendy A. Brown

  2. Centre for Obesity Research and Education (CORE), Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Prahran, 3181, Australia

    Paul R. Burton, Geraldine J. Ooi, Cheryl Laurie, Paul E. O’Brien & Wendy A. Brown

Authors
  1. Paul R. Burton
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  2. Geraldine J. Ooi
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  3. Cheryl Laurie
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  4. Kalai Shaw
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  5. Paul E. O’Brien
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  6. Andrew Smith
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  7. Peter D. Nottle
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  8. Wendy A. Brown
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Corresponding author

Correspondence to Paul R. Burton.

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Conflict of Interests

The Centre for Obesity Research and Education has received funding for research purposes from Allergan, Inc., the manufacturer of the LAP-BAND. Dr. Ooi reports scholarships from the National Health and Medical Research Council and the Royal Australasian College of Surgeons. PRB, CL, PN, KS, AS, PEO and WAB have no other disclosures or conflicts of interest.

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Burton, P.R., Ooi, G.J., Laurie, C. et al. Diagnosis and Management of Oesophageal Cancer in Bariatric Surgical Patients. J Gastrointest Surg 20, 1683–1691 (2016). https://doi.org/10.1007/s11605-016-3221-0

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  • DOI: https://doi.org/10.1007/s11605-016-3221-0

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