DE NOVO GASTROESOPHAGEAL JUNCTION CANCER AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY
Laura Mazer*, Michael Choi, Laith H. Jamil, Miguel Burch
Surgery, Cedars Sinai Medical Center, West Hollywood, CA
Background:
While rates of gastric cancer are decreasing worldwide, gastroesophageal junction (GEJ) cancer rates continue to rise in the United States. This is likely driven by rising rates of gastroesophageal reflux disease (GERD), related to rising obesity rates. Sleeve gastrectomy is now the most common bariatric operation performed nationwide, comprising 59% of the bariatric surgery volume, or a total of 135,000 patients annually. While a majority of patients have improved GERD after sleeve, there is a minority (2-18%) who will develop new or worsening symptoms. Theoretically, this population is at higher risk for esophageal and GEJ cancers. There are less than ten case reports internationally of new onset GEJ cancer after sleeve gastrectomy, but it is critically important to continue reporting new cases in order to understand the true risk of gastroesophageal cancer in patients with GERD after sleeve gastrectomy.
Case discussion:
We will present two patients who developed GEJ cancer in the setting of de novo GERD after sleeve gastrectomy. One 58-year-old man with hypertension, obstructive sleep apnea, and hyperlipidemia with BMI 42 underwent laparoscopic sleeve gastrectomy (LSG) in 2011. The second patient was a 70-year-old man with hypertension, diabetes, and obstructive sleep apnea who also underwent sleeve gastrectomy for morbid obesity in 2013. The initial operations were both at outside hospitals, five years prior to diagnosis with gastric cancer. Both patients developed new onset GERD soon after their sleeve, and were treated successfully with daily proton pump inhibitor with no daily symptoms. Both patients experienced good weight loss; body mass index at time of diagnosis with gastric cancer was 26 and 28 kg/m2. Both tumors were Siewert type II. The first patient had an endoscopic mucosal resection of his superficial adenocarcinoma, and is doing well with no evidence of disease on endoscopic surveillance 18 months later. The second patient is currently being scheduled for resection of a T1b tumor, and the options under discussion include a possible colon interposition graft versus definitive chemoradiation.
Conclusions:
GEJ cancer is a unique challenge after sleeve gastrectomy. The sleeve resection means that patients do not have the option of traditional anti-reflux surgery, and if cancer does develop the standard gastric conduit is not possible in the setting of an esophagectomy. The cases presented here are patients who had been responsive to PPI therapy for over 4 years. No screening criteria currently exist for the more than 700,000 patients who have undergone SG in the United States since 2010, and they are not included in any guidelines. More research is needed to understand the incidence and etiology of this disease, and the options for surgical treatment.
Back to 2019 Posters
