Gastric Cancer in a Patient with Laparoscopic Adjustable Gastric Band: Case Report and Review of Literature

Gastric cancer after laparoscopic adjustable gastric banding: A case report

INTRODUCTION

Gastric cancer occurring after bariatric and metabolic surgeries is rare. We report a case of gastric cancer that developed at 14 years after laparoscopic adjustable gastric banding.

PRESENTATION OF CASE

The patient was an obese 81-year-old woman who underwent LAGB at 14 years prior when her body mass index was 35.3 kg/m2. Anemia was noted during a visit to her family clinic. Subsequent esophagogastroduodenoscopy revealed a type 5 lesion (Macroscopic Classification of the Gastric Cancer in Japanese Classification of Gastric Carcinoma, The 15th Edition) near the greater curvature of the posterior wall of the gastric antrum. A biopsy indicated a poorly differentiated adenocarcinoma. Computed tomography showed no evidence of invasion of other organs, lymph node metastasis, or distant metastasis. The patient underwent laparoscopy-assisted distal gastrectomy, banding removal, Roux-en-Y reconstruction. The histopathological diagnosis was pT3N2M0 and pStage IIIA. The patient exhibited an uneventful postoperative course and was discharged on postoperative day 8. The patient has remained recurrence-free up to 12 months postoperatively.

DISCUSSION

While metabolic surgeries have been shown to reduce the risk of developing malignant diseases, including gastric cancer, the present patient developed gastric cancer at 14 years after laparoscopic adjustable gastric banding. The patient developed gastric cancer during a long-term course, indicating the importance of periodic examinations after metabolic surgery.

CONCLUSIONS

Previous studies showed metabolic surgeries for obesity reduce the risk of developing malignancies, including gastric cancer; however, the present case suggests that gastric cancer may develop over a long-term course.

Esophageal Squamous Cell Carcinoma After Adjustable Gastric Banding

The prevalence of morbid obesity has been increasing worldwide. Therefore, multiple laparoscopic adjustable gastric bandings (LAGBs) have been placed in Belgium in the nineties. The procedure was considered as minimal invasive with low morbidity rates. However, some publication cases suggest a possible association between LAGB and the onset of an esophageal cancer. We present a case of a 49-year-old female who consulted for dysphagia, epigastric pain, and anorexia 17 years after LAGB. An esophageal squamous cell carcinoma was diagnosed in the distal esophagus, close to the lap band. The diagnostic value of the performed contrast swallow study seemed limited. We suggest that a routinely gastroscopic evaluation in the long-term follow-up after LAGB should be strived for in patients presenting with late-onset dysphagia.