Esophageal carcinoma following bariatric procedures.
BACKGROUND
The long-term success of bariatric operations for weight reduction has been well documented, but their potential effects on the risk of esophageal cancer have not been evaluated.


METHODS
We performed operations on 3 patients for esophageal cancer following bariatric operations: 2 had Roux-en-Y gastric bypass, and 1 underwent vertical banded gastroplasty. All of these patients had adenocarcinoma at the gastroesophageal junction; 1 involved the entire intrathoracic esophagus.


RESULTS
The intervals between the weight-loss operations and cancer diagnoses were 21, 16, and 14 years. All 3 patients had symptoms of reflux for many years before dysphagia developed and cancer was diagnosed. We performed a limited esophagogastrectomy, a classic Ivor-Lewis procedure, and a total esophagectomy with jejunal free-tissue transfer from stomach to cervical esophagus. Two patients had positive lymph nodes. One patient is alive at 6 years; 2 died at 13 and 15 months after undergoing operation for recurrent cancer.


CONCLUSIONS
The effect of bariatric operations on gastroesophageal reflux is not known, although gastric bypass has been advocated as the "ultimate antireflux procedure." The presence of esophageal cancer in these 3 patients years after the weight loss operation is worrisome. We believe that patients who develop new symptoms should have endoscopic evaluation and that epidemiologic studies on the incidence of esophageal cancer occurring years after bariatric operation should be performed.
Allen
Jeff W
JW
Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky 40292, USA. jeffa@iglou.com
Leeman
Matthew F
MF
Richardson
J David
JD
D000230:Adenocarcinoma / Q000209:etiology* / Q000601:surgery; D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D003680:Deglutition Disorders / Q000209:etiology; D004938:Esophageal Neoplasms / Q000209:etiology* / Q000601:surgery; D016629:Esophagectomy / Q000379:methods; D017809:Fatal Outcome; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000209:etiology; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009767:Obesity, Morbid / Q000601:surgery; D016896:Treatment Outcome