1
|
Seidemann L, Dietrich A. Newly diagnosed Crohn's disease, and hepatocellular and renal cell carcinoma in a bariatric surgery patient-dealing with the complexity of obesity-associated diseases: a case report and review of the literature. J Med Case Rep 2023; 17:379. [PMID: 37667406 PMCID: PMC10478449 DOI: 10.1186/s13256-023-04111-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Bariatric surgery candidates commonly suffer from conditions that constitute the metabolic syndrome. But they also have a higher risk for autoimmune and malignant diseases. Obesity-associated comorbidities aside from the metabolic syndrome are often given insufficient attention in the clinical routine, including preoperative work-ups for bariatric surgery. CASE PRESENTATION We retrospectively report the case of a 65 years old Caucasian patient who was diagnosed with Crohn's disease prior to, a hepatocellular carcinoma during, and a renal cell carcinoma post bariatric surgery. The relevance of these diseases for decision making in bariatric procedures and current recommendations for preoperative bariatric work-ups are discussed. In our case, the diagnosis of Crohn's disease led to the performance of a sleeve gastrectomy instead of a Roux-en-Y gastric bypass and a previously unknown hepatocellular carcinoma was simultaneously removed by hepatic wedge resection. CONCLUSIONS Preoperative endoscopy and imaging techniques can be valuable since surprising pre- and intraoperative findings can force the bariatric surgeon to change the initially planned operative strategy. But the diagnostic accuracy of abdominal ultrasound may be limited in bariatric surgery patients. With the expansion of bariatric surgery, the complexity of bariatric surgery patients is also likely to increase. However, with the appropriate awareness and strategies, bariatric surgery can be safely executed and even contribute to the treatment of severe comorbidities that exceed the metabolic spectrum.
Collapse
Affiliation(s)
- Lena Seidemann
- Department of Bariatric, Metabolic and Endocrine Surgery, Clinic for Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Liebigstr. 20, 04103, Leipzig, Germany.
| | - Arne Dietrich
- Department of Bariatric, Metabolic and Endocrine Surgery, Clinic for Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Liebigstr. 20, 04103, Leipzig, Germany
| |
Collapse
|
2
|
Chiappetta S, Bottino V, Farina A. Can Bariatric and Metabolic Surgery Prevent Cancer Recurrence in Obesity-Related Neoplasms? Obes Surg 2022; 32:3469-3470. [PMID: 35902541 DOI: 10.1007/s11695-022-06230-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 07/19/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Sonja Chiappetta
- Bariatric and Metabolic Surgery Unit, Department of General Surgery, Ospedale Evangelico Betania, Via Argine 604, 80147, Naples, Italy.
| | - Vincenzo Bottino
- Department of General Surgery, Ospedale Evangelico Betania, Naples, Italy
| | - Amalia Farina
- Breast Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| |
Collapse
|
3
|
Carter J, Chang J, Birriel TJ, Moustarah F, Sogg S, Goodpaster K, Benson-Davies S, Chapmon K, Eisenberg D. ASMBS position statement on preoperative patient optimization before metabolic and bariatric surgery. Surg Obes Relat Dis 2021; 17:1956-1976. [PMID: 34629296 DOI: 10.1016/j.soard.2021.08.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/11/2021] [Accepted: 08/27/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Jonathan Carter
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California.
| | - Julietta Chang
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - T Javier Birriel
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Fady Moustarah
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Stephanie Sogg
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Kasey Goodpaster
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Sue Benson-Davies
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Katie Chapmon
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Dan Eisenberg
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| |
Collapse
|
4
|
Malik PRA, Doumouras AG, Malhan RS, Lee Y, Boudreau V, Barlow K, Karpinski M, Anvari M. Obesity, Cancer, and Risk Reduction with Bariatric Surgery. Surg Clin North Am 2021; 101:239-254. [PMID: 33743967 DOI: 10.1016/j.suc.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The prevalence of noncommunicable diseases has increased dramatically in North America and throughout the world and is expected to continue increasing in coming years. Obesity has been linked to several types of cancers and is associated with increased morbidity and mortality following cancer diagnosis. Bariatric surgery has emerged as the prominent model to evaluate the effects of intentional weight loss on cancer incidence and outcomes. Current literature, comprising prospective cohort investigations, indicates site-specific reductions in cancer risk with select bariatric procedures. Future research is required to establish evidence-based indications for bariatric surgery in the context of cancer prevention.
Collapse
Affiliation(s)
- Peter R A Malik
- Department of Surgery and Centre for Minimal Access Surgery, St. Joseph's Healthcare, 50 Charlton Avenue East, Rm T2141 Hamilton, Ontario L8N 4A6, Canada; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, Ontario L8S 4K1, Canada
| | - Aristithes G Doumouras
- Department of Surgery and Centre for Minimal Access Surgery, St. Joseph's Healthcare, 50 Charlton Avenue East, Rm T2141 Hamilton, Ontario L8N 4A6, Canada
| | - Roshan S Malhan
- Department of Surgery and Centre for Minimal Access Surgery, St. Joseph's Healthcare, 50 Charlton Avenue East, Rm T2141 Hamilton, Ontario L8N 4A6, Canada
| | - Yung Lee
- Department of Surgery and Centre for Minimal Access Surgery, St. Joseph's Healthcare, 50 Charlton Avenue East, Rm T2141 Hamilton, Ontario L8N 4A6, Canada
| | - Vanessa Boudreau
- Department of Surgery and Centre for Minimal Access Surgery, St. Joseph's Healthcare, 50 Charlton Avenue East, Rm T2141 Hamilton, Ontario L8N 4A6, Canada; Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, Ontario L8S 4K1, Canada
| | - Karen Barlow
- Department of Surgery and Centre for Minimal Access Surgery, St. Joseph's Healthcare, 50 Charlton Avenue East, Rm T2141 Hamilton, Ontario L8N 4A6, Canada
| | - Marta Karpinski
- Department of Health Research Methods, Evidence & Impact, Faculty of Health Sciences, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, Ontario L8S 4K1, Canada
| | - Mehran Anvari
- Department of Surgery and Centre for Minimal Access Surgery, St. Joseph's Healthcare, 50 Charlton Avenue East, Rm T2141 Hamilton, Ontario L8N 4A6, Canada.
| |
Collapse
|
5
|
Malignancy in bariatric surgery patients: a French multisite cohort. Surg Endosc 2020; 35:6021-6030. [PMID: 33078225 DOI: 10.1007/s00464-020-08091-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Bariatric surgery is associated with decreased cancer-related mortality. An indefinite proportion of patients that undergo bariatric surgery have a history of malignancy or will develop cancer. In these patients, weight loss and oncologic evolution needed to be assessed. The aim of this study was to report the results of patients diagnosed with malignancy before and after bariatric surgery in a French multisite cohort. METHODS We conducted a retrospective cohort study of all patients who underwent bariatric surgery in six university centers. Patients were divided in two groups: patients with a preoperative history of malignancy and patients diagnosed with malignancy during the follow-up. Both groups were compared with control groups of patients that underwent surgery during the same period. RESULTS From 2008 to 2018, 8927 patients underwent bariatric surgery. In patients with a history of malignancy (n = 90), breast and gynecologic cancers were predominant (37.8%). Median interval between malignancy and surgery was 60 (38-118) months. After a follow-up of 24 (4-52) months, 4 patients presented with cancer recurrence. Comparative analysis demonstrated equivalent weight loss one year after surgery. In patients with postoperative malignancy (n = 32), breast and gynecologic cancers were also predominant (40.6%). Median interval between surgery and malignancy was 22 (6-109) months. In the comparative analysis, weight loss was similar at 2 years. CONCLUSIONS History of malignancy should not be considered as an absolute contraindication for bariatric surgery. Gynecological cancer screening should be reinforced before and after surgery. The development of malignancy postoperatively does not seem to affect mid-term bariatric outcomes.
Collapse
|
6
|
Lack of benefit of routine abdominal CT-scan before bariatric surgery. J Visc Surg 2020; 158:390-394. [PMID: 32917578 DOI: 10.1016/j.jviscsurg.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Scientific societies recommend to seek cancer prior to bariatric surgery. In our tertiary referral center, we aimed to study performance of abdominal CT-scan before bariatric surgery. PATIENTS AND METHODS We retrospectively included all patients who underwent bariatric surgery and a pre-operative abdominal CT-scan in our academic center, between January 2015 and December 2018. RESULTS We included 521 patients (417 women and 104 men) with a mean age of 48.0±11.5 years. Mean preoperative body mass index was 44.9±7.0kg/m2. Among the 392 patients with abnormal CT-scan, mean number of anomalies per patient was of 2.2±1.2. Vast majority of anomalies (91.8%) were non-significant. Only 5 (1%) patients needed treatment prior to bariatric surgery. No factor predictive of abnormal CT-scan was found. CONCLUSION Only few patients had severe anomaly on CT-scan before bariatric surgery. Abdominal CT-scan could not be advocated to seek cancer before bariatric surgery.
Collapse
|
7
|
ASMBS position statement on the relationship between obesity and cancer, and the role of bariatric surgery: risk, timing of treatment, effects on disease biology, and qualification for surgery. Surg Obes Relat Dis 2020; 16:713-724. [DOI: 10.1016/j.soard.2020.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 12/31/2022]
|
8
|
Winder AA, Kularatna M, MacCormick AD. Does Bariatric Surgery Affect the Incidence of Endometrial Cancer Development? A Systematic Review. Obes Surg 2019; 28:1433-1440. [PMID: 29512036 DOI: 10.1007/s11695-018-3151-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Obesity has been linked to an increased prevalence in multiple cancers. Studies have suggested a reduction in the overall risk of cancer after bariatric surgery. We reviewed the evidence for bariatric surgery reducing the risk of endometrial cancer. Data was extracted from PubMed, EMBASE, and Medline to perform a systematic review. Thirty-one full text articles were identified from 265 abstracts. Nine observational studies were relevant to endometrial cancer. In the five controlled studies, 462 of 113,032 (0.4%) patients receiving bariatric surgery versus 11,997 of 848,864 (1.4%) controls developed endometrial cancer, odds ratio of 0.317 (95% CI 0.161 to 0.627) using random effects model (P < 0.001). Bariatric surgery seems to reduce the risk of endometrial cancer; however, more research is required.
Collapse
Affiliation(s)
- Alec A Winder
- Department of General Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand. .,, London, UK.
| | - Malsha Kularatna
- Department of General Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Andrew D MacCormick
- Department of General Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
| |
Collapse
|
9
|
Winder AA, Kularatna M, MacCormick AD. Does Bariatric Surgery Affect the Incidence of Breast Cancer Development? A Systematic Review. Obes Surg 2018; 27:3014-3020. [PMID: 28840450 DOI: 10.1007/s11695-017-2901-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We reviewed the evidence for bariatric surgery reducing the risk of breast cancer. Data was extracted from multiple libraries, including PubMed, EMBASE, and Medline, to perform a systematic review. Abstracts were reviewed by two independent reviewers. Thirty-eight full-text articles were identified from 1171 abstracts. Four studies were included for meta-analysis; 114 of 10,533 (1.1%) patients receiving bariatric surgery versus 516 of 20,130 (2.6%) controls developed breast cancer, odds ratio 0.564 (95% CI 0.453 to 0.702) using a fixed effects model (P < 0.001) and odds ratio 0.585 (95% CI 0.247 to 1.386) using a random effects model (P 0.223). Bariatric surgery may reduce the risk of breast cancer. More research is required due to heterogeneity of studies, difficulty in identifying accurate controls, and limited follow-up.
Collapse
Affiliation(s)
- Alec A Winder
- Department of General Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand.
| | - Malsha Kularatna
- Department of General Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Andrew D MacCormick
- Department of General Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
| |
Collapse
|
10
|
Pérez-Segura P, Palacio JE, Vázquez L, Monereo S, de Las Peñas R, de Icaya PM, Grávalos C, Lecube A, Blasco A, García-Almeida JM, Barneto I, Goday A. Peculiarities of the obese patient with cancer: a national consensus statement by the Spanish Society for the Study of Obesity and the Spanish Society of Medical Oncology. Clin Transl Oncol 2017; 19:682-694. [PMID: 28074400 DOI: 10.1007/s12094-016-1601-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/16/2016] [Indexed: 12/14/2022]
Abstract
The relationship between obesity and cancer is clear and is present at all times during course of the disease. The importance of obesity in increasing the risk of developing cancer is well known, and some of the most prevalent tumours (breast, colorectal, and prostate) are directly related to this risk increase. However, there is less information available on the role that obesity plays when the patient has already been diagnosed with cancer. Certain data demonstrate that in some types of cancer, obese patients tolerate the treatments more poorly. Obesity is also known to have an impact on the prognosis, favouring lower survival rates or the appearance of secondary tumours. In this consensus statement, we will analyse the scientific evidence on the role that obesity plays in patients already diagnosed with cancer, and the available data on how obesity control can improve the quality of daily life for the cancer patient.
Collapse
Affiliation(s)
- P Pérez-Segura
- Servicio de Oncología Médica, Hospital Clínico Universitario San Carlos, Calle Profesor Martín Lagos, s/n, 28040, Madrid, Spain.
| | - J E Palacio
- Servicio de Endocrinología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
| | - L Vázquez
- Servicio de Oncología Médica, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
| | - S Monereo
- Servicio de Endocrinología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R de Las Peñas
- Servicio de Oncología Médica, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Castellón, Spain
| | - P Martínez de Icaya
- Servicio de Endocrinología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - C Grávalos
- Servicio de Oncología Médica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Lecube
- Servicio de Endocrinología, Hospital Arnau de Vilanova, Lleida, Spain
| | - A Blasco
- Servicio de Oncología Médica, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - J M García-Almeida
- Servicio de Endocrinología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - I Barneto
- Servicio de Oncología Médica, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - A Goday
- Servicio de Endocrinología, Hospital del Mar, Barcelona, Spain.,Departament de Medicina, IMIM Institut Mar de Investigacions Mediques, CiberOBN, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
11
|
De Luca M, Angrisani L, Himpens J, Busetto L, Scopinaro N, Weiner R, Sartori A, Stier C, Lakdawala M, Bhasker AG, Buchwald H, Dixon J, Chiappetta S, Kolberg HC, Frühbeck G, Sarwer DB, Suter M, Soricelli E, Blüher M, Vilallonga R, Sharma A, Shikora S. Indications for Surgery for Obesity and Weight-Related Diseases: Position Statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg 2016; 26:1659-96. [PMID: 27412673 PMCID: PMC6037181 DOI: 10.1007/s11695-016-2271-4] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Maurizio De Luca
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy.
| | | | - Jacques Himpens
- The European School of Laparoscopic Surgery, Brussels, Belgium
| | | | | | | | - Alberto Sartori
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy
| | | | | | | | | | - John Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | | | - Michel Suter
- University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Mattias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | | | - Arya Sharma
- Obesity Research Management, University of Alberta, Edmonton, Canada
| | | |
Collapse
|
12
|
Meredith I, Lim YK, Wickremesekera SK, Bann S. Experience of imaging following laparoscopic sleeve gastrectomy. ANZ J Surg 2015; 86:568-71. [PMID: 26333708 DOI: 10.1111/ans.13284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND We aimed to report our experience with upper gastrointestinal (UGI) contrast studies and computed tomography (CT) swallow studies after laparoscopic sleeve gastrectomy, and comment on the merits of each modality. METHOD Retrospective review of all patients undergoing laparoscopic sleeve gastrectomy (LSG) in a New Zealand hospital between 2011 and 2014 was conducted. Over this time period, routine UGI was replaced by CT swallow studies. All medical records and radiology were reviewed and pertinent findings reported. RESULTS Seventy-nine patients underwent LSG over this time period and one patient had to be excluded; 48 (61.5%) had a UGI study and 30 patients (38.5%) had CT swallow. There were no leaks in this study and no leaks became clinically significant. Sixteen of 30 patients (53.3%) undergoing CT swallow had significant incidental findings demonstrated on axial imaging that required follow-up. CONCLUSION CT swallow can provide the same information as a UGI but has a significant rate of incidental findings. The rate of incidental pathology on CT is higher than that quoted in the general population. In a bariatric population, this may allow early detection and treatment of co-existent pathology.
Collapse
Affiliation(s)
- Ineke Meredith
- Department of General Surgery, North Shore Hospital, Auckland, New Zealand.,Wellington School of Medicine, University of Otago, Wellington, New Zealand
| | - Yu Kai Lim
- Department of General Surgery, Wellington Regional Hospital, Wellington, New Zealand
| | | | - Simon Bann
- Wellington School of Medicine, University of Otago, Wellington, New Zealand.,Department of General Surgery, Wellington Regional Hospital, Wellington, New Zealand.,Victoria University, Wellington, New Zealand
| |
Collapse
|
13
|
Casagrande DS, Rosa DD, Umpierre D, Sarmento RA, Rodrigues CG, Schaan BD. Incidence of cancer following bariatric surgery: systematic review and meta-analysis. Obes Surg 2015; 24:1499-509. [PMID: 24817500 DOI: 10.1007/s11695-014-1276-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Obesity is linked to the development of cancer. Previous studies have suggested that there is a relationship between bariatric surgery and reduced cancer risk. Data sources were from Medline, Embase, and Cochrane Library. From 951 references, 13 studies met the inclusion criteria (54,257 participants). In controlled studies, bariatric surgery was associated with a reduction in the risk of cancer. The cancer incidence density rate was 1.06 cases per 1000 person-years within the surgery groups. In the meta-regression, we found an inverse relationship between the presurgical body mass index and cancer incidence after surgery (beta coefficient -0.2, P < 0.05). Bariatric surgery is associated with reduced cancer risk in morbidly obese people. However, considering the heterogeneity among the studies, conclusions should be drawn with care.
Collapse
Affiliation(s)
- Daniela Schaan Casagrande
- Postgraduate Program in Medical Sciences: Endocrinology and Metabolism, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos 2350, prédio 12, 4° andar, 90035-003, Porto Alegre, RS, Brazil
| | | | | | | | | | | |
Collapse
|
14
|
Upala S, Anawin Sanguankeo. Bariatric surgery and risk of postoperative endometrial cancer: a systematic review and meta-analysis. Surg Obes Relat Dis 2015; 11:949-55. [DOI: 10.1016/j.soard.2014.09.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/29/2014] [Indexed: 12/22/2022]
|
15
|
Moten A, Jeffers K, Larbi D, Smith-White R, Taylor T, Wilson L, Adenuga B, Frederick W, Laiyemo A. Obesity and Weight Loss Attempts among Subjects with a Personal History of Cancer. Sultan Qaboos Univ Med J 2014; 14:e330-e336. [PMID: 25097767 PMCID: PMC4117657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 02/02/2014] [Accepted: 02/18/2014] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES Obesity is a risk factor for many cancers and obese cancer patients have a poorer prognosis. This study aimed to evaluate the prevalence of obesity and attempts to lose weight among cancer survivors. The effects of cancer treatment and time since cancer treatment were also evaluated. METHODS The 2007 Health Information National Trends Survey data were analysed between 2011 and 2013; respondents with (n = 966) and without (n = 6,093) a personal history of cancer were identified. Each respondent's body mass index (BMI) was calculated using self-reported height and weight measurements and categorised as normal (<25 kg/m(2)), overweight (25-29.9 kg/m(2)) or obese (≥30 kg/m(2)). RESULTS Cancer survivors were older (mean age = 63.4 versus 44.7 years for those with no history of cancer). Overall, there were similar percentages of overweight (37.6% versus 34.1%; relative risk ratio [RRR] = 0.99; 95% confidence interval [CI]: 0.75-1.31) and obese (31.4% versus 27.5%; RRR = 1.04; 95% CI: 0.79 1.39) respondents among both cancer survivors and those without a history of cancer. Among overweight and obese participants, cancer survivors did not demonstrate increased weight loss attempts compared to those without a history of cancer (61.6% versus 66.3%; odds ratio = 0.94; 95% CI: 0.73 1.20). CONCLUSION A high prevalence of overweight and obese cancer survivors were identified without any association with cancer treatment. However, cancer survivors did not demonstrate increased attempts to lose weight in comparison to those without a history of cancer despite awareness of their degree of body fatness. Increased efforts to promote the maintenance of a healthy weight among cancer survivors are needed.
Collapse
Affiliation(s)
- Ambria Moten
- Departments of Medicine, Howard University, Washington D.C., USA
| | - Kayin Jeffers
- Departments of Medicine, Howard University, Washington D.C., USA
| | - Daniel Larbi
- Departments of Medicine, Howard University, Washington D.C., USA
| | | | | | - Lori Wilson
- Surgery, Howard University, Washington D.C., USA
| | | | - Wayne Frederick
- Howard University Cancer Center, Washington D.C., USA
- Surgery, Howard University, Washington D.C., USA
| | - Adeyinka Laiyemo
- Departments of Medicine, Howard University, Washington D.C., USA
| |
Collapse
|
16
|
Tee MC, Cao Y, Warnock GL, Hu FB, Chavarro JE. Effect of bariatric surgery on oncologic outcomes: a systematic review and meta-analysis. Surg Endosc 2013; 27:4449-56. [PMID: 23949484 PMCID: PMC4018832 DOI: 10.1007/s00464-013-3127-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 07/17/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Obesity is a major public health issue and is associated with increased risk of several cancers, currently a leading cause of mortality. Obese patients undergoing bariatric surgery may allow for evaluation of the effect of intentional excess weight loss on subsequent risk of cancer. We aimed to evaluate cancer risk, incidence, and mortality after bariatric surgery. METHODS A comprehensive literature search was conducted using PubMed/MEDLINE and Embase with literature published from the inception of both databases to January 2012. Inclusion criteria incorporated all human studies examining oncologic outcomes after bariatric surgery. Two authors independently reviewed selected studies and relevant articles from their bibliographies for data extraction, quality appraisal, and meta-analysis. RESULTS Six observational studies (n = 51,740) comparing relative risk (RR) of cancer in obese patients undergoing bariatric surgery versus obese control subjects were analyzed. Overall, the RR of cancer in obese patients after undergoing bariatric surgery was 0.55 [95% confidence interval (CI) 0.41-0.73, p < 0.0001, I(2) = 83%]. The effect of bariatric surgery on cancer risk was modified by gender (p = 0.021). The pooled RR in women was 0.68 (95% CI 0.60-0.77, p < 0.0001, I(2) < 0.1%) and in men was 0.99 (95% CI 0.74-1.32, p = 0.937, I(2) < 0.1%). CONCLUSIONS Bariatric surgery reduces cancer risk and mortality in formerly obese patients. When stratifying the meta-analysis by gender, the effect of bariatric surgery on oncologic outcomes is protective in women but not in men.
Collapse
Affiliation(s)
- May C Tee
- MPH Program, Harvard School of Public Health, Boston, MA, USA,
| | | | | | | | | |
Collapse
|
17
|
Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, Heinberg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring) 2013; 21 Suppl 1:S1-27. [PMID: 23529939 PMCID: PMC4142593 DOI: 10.1002/oby.20461] [Citation(s) in RCA: 741] [Impact Index Per Article: 67.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 12/27/2012] [Indexed: 02/06/2023]
Abstract
The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
Collapse
|
18
|
Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, Heinberg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Endocr Pract 2013; 19:337-72. [PMID: 23529351 PMCID: PMC4140628 DOI: 10.4158/ep12437.gl] [Citation(s) in RCA: 279] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
Collapse
|
19
|
Abstract
BACKGROUND Obesity is associated with several comorbidities like diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea. It is also well established that obese patients have an increased risk of several types of cancer like kidney, pancreas, endometrial, breast, and others. The bariatric surgeon needs to be aware of the problem of benign tumors and cancer in obese patients as well as the optimal management of these conditions that may be present at the time of evaluation for bariatric surgery, during the surgical procedure, and in the postoperative period. DATABASE A PubMed search for the words "cancer" and "bariatric surgery" and subsequent review of the abstracts identified 40 articles concerning cancerous, benign, and premalignant conditions in bariatric surgery patients. Data were then extracted from full-text articles. CONCLUSION Bariatric surgery decreases cancer risk especially in women. RYGB can be an effective treatment for Barrett's esophagus. Patients having esophageal cancer should not undergo bariatric surgery, while those who develop the same postoperatively are usually managed by a combined abdominal and thoracic approach (Ivor Lewis technique). Gastric cancer of the remnant stomach is usually managed by a remnant gastrectomy. A remnant gastrectomy during RYGB would be necessary in conditions that require endoscopic surveillance of the stomach like gastric polyps, intestinal metaplasia, and carcinoid tumors. Sleeve gastrectomy is an excellent option in a patient with GIST or a carcinoid who needs a bariatric operation. Preoperative endoscopy usually does not detect malignant conditions. Postoperative evaluation of the bypassed stomach is possible using various percutaneous and novel endoscopic techniques.
Collapse
Affiliation(s)
- Rao S Raghavendra
- Division of Metabolic Endocrine and Minimally Invasive Surgery, Mount Sinai Medical Center, NY, New York, USA.
| | | |
Collapse
|
20
|
Mechanick JI, Youdim A, Jones DB, Timothy Garvey W, Hurley DL, Molly McMahon M, Heinberg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis 2013; 9:159-91. [PMID: 23537696 DOI: 10.1016/j.soard.2012.12.010] [Citation(s) in RCA: 430] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 12/27/2012] [Indexed: 02/06/2023]
Abstract
The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
Collapse
|
21
|
Metabolic or bariatric surgery? Long-term effects of malabsorptive vs restrictive bariatric techniques on body composition and cardiometabolic risk factors. Int J Obes (Lond) 2010; 34:1404-14. [PMID: 20404828 DOI: 10.1038/ijo.2010.54] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Obesity is an increasing health problem and surgery seems to be the only treatment effective in achieving weight loss without relapse. Among bariatric techniques, many differences exist in terms of weight loss and resolution of comorbidities. Up to now, there are no prospective studies comparing long-term effects of malabsorptive vs restrictive techniques. OBJECTIVE In this study, cardiometabolic risk factors and body composition changes after malabsorptive biliointestinal bypass (BIBP) and restrictive laparoscopic adjustable gastric banding (LAGB) were compared during a 4-year follow-up. DESIGN Prospective, case-control and cohort study. PATIENTS In all, 80 obese subjects, matched for weight and age. Altogether, 40 patients underwent BIBP and 40 underwent LAGB. MEASUREMENTS Weight, body composition, fasting and post-loading plasma glucose and insulin, homeostatic model assessment index (HOMA-I), lipid profile, blood pressure (BP), erythrocyte sedimentation rate and fibrinogen were monitored at baseline, 12 and 48 months. RESULTS At 12 months after surgery, a significant reduction in body mass index, total fat mass (FM), trunk FM (trFM), trFM/legs FM (lFM) ratio (trFM/lFM), triglycerides, BP and inflammation markers was observed in both groups. BIBP patients showed a significant reduction in total cholesterol (Tot-C), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), whereas the LAGB group showed a significant increase of HDL-C. A further improvement of all the parameters evaluated was seen in the BIBP group at 48 months after surgery. CONCLUSIONS Both bariatric procedures exerted positive effects on cardiometabolic risk factors and on weight loss in the population studied, but on the long-term period, HOMA-I, Tot-C/HDL-C ratio and body composition improvements were more evident after BIBP. We conclude that malabsorptive BIBP seems to be more effective than LAGB in treating visceral obesity and its metabolic complications.
Collapse
|
22
|
Crea N, Pata G, Di Betta E, Titi A, Mittempergher F. High Incidence of Appendix Carcinoid Tumors Among Candidates for Bariatric Surgery: Diagnostic and Therapeutic Implications. Obes Surg 2010; 21:151-6. [DOI: 10.1007/s11695-010-0112-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|