title: Minimally invasive esophagectomy is safe in patients with previous gastric bypass.
abstract: BACKGROUND
  The prevalence of morbid obesity in the United States has been steadily increasing, and there is an established relationship between obesity and the risk of developing certain cancers. Patients who have undergone prior gastric bypass (GB) and present with newly diagnosed esophageal cancer represent a new and challenging cohort for surgical resection of their disease. We present our case series of consecutive patients with previous GB who underwent minimally invasive esophagectomy (MIE).
  
  
  METHODS
  Retrospective review of consecutive patients with a history of GB who underwent a MIE for esophageal cancer between July 2010 and August 2012.
  
  
  RESULTS
  Five patients were identified with a mean age of 57 years. Mean follow-up was 9.1 months. Four patients had undergone laparoscopic GB, and 1 patient had an open GB. Two patients received neoadjuvant chemoradiation therapy for locally advanced disease. Minimally invasive procedures were thoracoscopic/laparoscopic esophagectomy with cervical anastomosis in 4 patients and colonic interposition in 1 patient. Mean operative time was 6 hours and 52 minutes. Median length of stay was 7 days. There was no mortality. Postoperative complications occurred in 3 patients and included pneumonia/respiratory failure, recurrent laryngeal nerve injury, and pyloric stenosis. All patients are alive and disease free at last follow-up.
  
  
  CONCLUSIONS
  Minimally invasive esophagectomy after prior GB is well tolerated, is technically feasible, and has acceptable oncologic and perioperative outcomes. We conclude that precise endoscopic evaluation before bariatric surgery in patients with gastroesophageal reflux disease is essential, as is the necessity for continuing postsurgical surveillance in patients with known Barrett's esophagitis and for early evaluation in patients who develop new symptoms of gastroesophageal reflux disease after bariatric surgery.
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Georgios
authors.initials: G
authors.lastname: Rossidis
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Robert
authors.initials: R
authors.lastname: Browning
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Steven N
authors.initials: SN
authors.lastname: Hochwald
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Husain
authors.initials: H
authors.lastname: Abbas
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Tad
authors.initials: T
authors.lastname: Kim
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, Florida. Electronic address: kfir.ben-david@surgery.ufl.edu.
authors.forename: Kfir
authors.initials: K
authors.lastname: Ben-David
mesh_terms: D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D061214:Patient Safety; D012189:Retrospective Studies; D024162:Second-Look Surgery; D013908:Thoracotomy / Q000379:methods
keywords: Esophageal cancer; Gastric bypass; Minimally invasive esophagectomy