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According to the World Health Organization, obesity is rising by 30 million cases per year,1 whereas the overall number of new cancer cases will increase by , cases per year. We conducted a review of the literature about the cases of gastric cancer arising after any bariatric procedure, including a case of adenocarcinoma incidentally discovered by the authors 6 months after laparoscopic adjustable gastric banding LAGB. The search was performed for English and French articles published from January 1, to June 30, relevant to gastric cancer after bariatric surgery.
Literature Screening Received for publication November 3, ; accepted January 4, In phase 1, the following types of studies were excluded: In phase 2, abstracts were reviewed for relevance and the full-text articles were obtained. The review included all cases of obesity surgery with a diagnosis of gastric tumor after intervention.
The studies had to describe Z1 of the following parameters: Flow diagram of the systematic literature search. Case Report L. Preoperative upper gastrointestinal endoscopy UGE did not reveal any pathology.
At 6 months after removing infected port, a UGE was performed to identify partial band erosion and a lesionof about 8 mm in the angulus Fig. Open total gastrectomy was performed removing en bloc the eroded banding, followed by a Roux-en-Y reconstruction. Histopathologic examination of the specimen showed intramucosal adenocarcinoma of 2 mm, without evidence of perineural and vascular invasion pT1sN0M0.
At the last follow-up in March her condition was well. The last patient is L. L, mentioned in the table. Poorly differentiated adenocarcinoma with signetring cells in the angulus. Only 1 patient underwent a loop gastric bypass, and another patient was operated on by a LAGB procedure removed 9 months later because of total intragastric migration and followed by RYGB.
No case of cancer after sleeve gastrectomy was reported. Localization of gastric tumor after bariatric procedures. Furthermore, the weight loss and the distension were the most common symptoms after pain in patients with cancer of remnant stomach, whereas the weight loss with nausea or vomiting and upper GI bleeding were the second most common symptoms in patients with cancer of the pouch Fig.
In contrast, surgery for morbid obesity is increasing in all industrialized countries and is becoming one of the most common types of surgery. The global total number of procedures in was ,, whereas in it was , The most commonly performed procedures were RYGB The risk has been recognized in the gastric stump with a 3-fold to 5-fold increase compared with the general population. Carcinoma classically develops 15 to 25 years postoperatively, most often near the anastomotic site.
For cancer of the excluded stomach in RYGB, it is notable that intestinal metaplasia and carcinogenesis are experimentally promoted by www. Most frequently reported symptoms in the gastric cancer after bariatric procedures. After restrictive procedures, the symptoms may also be attributed to dietary indiscretion. The early diagnosis of our case was incidental, because after the infected port was removed we decided to perform a UGE to evaluate the band.
Nevertheless, when new upper digestive tract complaints occur in any patient with an otherwise unremarkable bariatric surgery follow-up, the diagnosis of gastric cancer should be borne in mind.
The UGE could be considered the best choice in the diagnostic assessment of a patient with symptoms suggestive of esophagogastric neoplasms, except for exploring excluded stomach after RYGB.
For this reason, a preoperative upper endoscopy is mandatory before bariatric surgery31,32 but it is still not necessary to perform periodically an endoscopic exam after the intervention. Although the risk of the gastric cancer after bariatric procedures seems to be extremely low, prospective epidemiologic studies are required to evaluate patient-related or procedure-related risk. World Health Organization. Obesity and overweight fact sheet N Available at: Accessed January 15, Cancer-fact sheet N Bariatric surgery versus conventional medical therapy for type 2 diabetes.
N Engl J Med. Body-mass index and incidence of cancer: Adenocarcinoma of the pouch after silastic ring vertical gastroplasty. Obes Surg. Gastric cancer occurring after vertical banded gastroplasty. Cancer in the gastric remnant after gastric bypass: Curr Surg. Carcinoma in the gastric pouch years after vertical banded gastroplasty.
Band erosion with gastric cancer. Gastric cancer after Roux-en-Y gastric bypass. Gastric pouch carcinoma after gastric bypass for morbid obesity. Report of two cases of gastric cancer after bariatric surgery: Cancer in the excluded stomach 4 years after gastric bypass. Babor R, Booth M. Adenocarcinoma of the gastric pouch 26 years after loop gastric bypass. Cancer in the bypassed stomach presenting early after gastric bypass. Gastric pouch adenocarcinoma and tubular adenoma of the pylorus: Gastric adenocarcinoma after Roux-en-Y gastric bypass: Surg Obes Relat Dis.
Metastatic adenocarcinoma of the gastric pouch 5 years after Roux-en-Y gastric bypass. Gastric cancer after laparoscopic adjustable gastric banding. Rev Med Brux. Buchwald H, Oien DM. Gastric stump cancer: Dig Dis.
Gastric carcinoma after surgical treatment of peptic ulcer: Swedish Obese Subjects Study. Effects of bariatric surgery on cancer incidence in obese patients in Sweden Swedish Obese Subjects Study: Lancet Oncol. Is bile or are pancreaticoduodenal secretions related to gastric carcinogenesis in rats with reflux through the pylorus? J Cancer Res Clin Oncol. In relation to the different dimensions of the questionnaire, there were in fact significant differences to the detriment of the superobese group in the physical and social dimensions.
In the group of obese patients, 2, 42, 34, 16, 4. Figure 1 shows the significant progressive decrease in final GIQLI score depending on the number of comorbid conditions of the obese patient. Both scores decrease significantly as age increases.
No significant differences were found between both lines of the curve. The self-perspective a patient has of his or her own health bears great transcendence on all dimensions physical, mental, and social To this end, tools to measure HRQL have started to be developed There are questionnaires considered generic that have proven useful for the assessment of any disease or health status, and other have been specifically created for assessing specific diseases.
The GIQLI questionnaire is capable of providing information on generic as well as on specific aspects of digestive symptoms and quality of life. For this reason, GIQLI has been extensively used in different pathologies and to evaluate medical treatments or surgical procedures performed on the digestive tract In Spain, it has been possible to adapt and validate generic HRQL questionnaires , many of which have been administered to obese patients 2, Nevertheless, no studies have been conducted so far to evaluate quality of life in these patients that could at the same time be used to correlate changes occurring in these patients following bariatric surgery Given that bariatric surgery, in any of its techniques, modifies the anatomy and the normal functionality of the digestive tract, in our opinion the GIQLI questionnaire can be a very valuable tool to measure the patient's perception of his or her quality of life, mainly in relation to digestive discomfort and other possible side effects caused by the different surgical techniques.
The GIQLI questionnaire has been used to assess quality of life in morbidly obese patients because it affords the following advantages: -It provides information on the quality of life of the patient in relation to both generic aspects physical status, social relations, emotional status and specific aspects of the upper and lower digestive tract.
Other authors have demonstrated its value as a measurement tool for HRQL in obese patients The results obtained via questionnaires on the quality of life of morbidly obese patients, such as GIQLI, must be interpreted very cautiously due to a bias in the selection process. It is difficult to assess whether morbidly obese patients who were given the questionnaire showed more concern about their obesity than other obese patients, as they came to the practice with the intention of finding a definitive solution - surgery in this case.
Both study samples control group and MO were comparable, as no significant differences were found regarding age; while it is true that an unbalance existed with regard to gender, no significant differences were found in relation to age, BMI or GIQLI score between males and females. Some studies on public health have shown gender to have an influence on the way an individual perceives his or her health.
In males, the perception of health with regard to their obesity would decrease with age, in sharp contrast with the worst perception of females, especially in young obese women In our study we found no significant differences in quality of life between both genders in the control group.
However, significant differences were in fact found with regard to the quality of life in the MO group, with the perception of life being worse in women than in men. These differences are more evident in the emotional dimension of the test, with no significant differences found neither in the physical nor in the social dimensions or with regard to digestive symptoms.
These findings could mean that women with MO would be more emotionally labile than men, and that such feelings would transpire in their daily life thus causing more stress, anxiety, depression, and frustration. The score obtained in the control group of the study was similar to that obtained in the control group in the original study by Eypasch et al.
The group of healthy patients studied by the above-mentioned authors coincides demographically with our control group, both in age and gender. This similarity would confirm the adequate interpretation and completion of the questionnaire on the part of the population cared for and its validation.
Morbidly obese patients have a worse perception of their quality of life versus patients in the control group. This worse quality of life is the result of a marked alteration of digestive specific symptoms related to obesity, coupled with a worsening of physical, emotional and social status in the morbidly obese patient.
Using other questionnaires, both generic such as Fontaine and Barlett with the SF 33 and Kolotkin et al. All these authors refer to the impact that HRQL has on areas such as the patient's level of energy, social ability, role limitations due to emotional problems, and mental health, self-esteem and sexual life. According to some authors, obesity, being a chronic, systemic condition, has a strong repercussion not only on the different organs and systems of the patient's body degenerating effects but also on the psychological and social dimensions, as these patients often suffer from damaged self-esteem, depressed mood, emotional lability, higher anxiety, feelings of guilt, self-recrimination, and a deep feeling of frustration resulting from continued failure to achieve "ideal" weight standards despite great efforts to lose weight 37, The GIQLI questionnaire has been shown to be a reliable and valid questionnaire to measure quality of life in morbidly obese patients.
Morbidly obese patients have a worse perception of life than non-obese patients. Such deterioration in quality of life can be attributable to excessive body weight and the existence of comorbid conditions caused by obesity.
This worsening in quality of life is justified not only by a greater, obvious limitation of their physical condition physical dimension but also by a worse perception of the accompanying digestive symptomatology, the patient's social attitude social dimension , and his or her mind frame emotional dimension. Since the GIQLI questionnaire bears an important specific weight on the evaluation of the way a patient perceives his or her digestive symptoms, it can be a very useful tool in the assessment of the final outcome and side effects of bariatric surgery.
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