title: Diagnosis and Management of Oesophageal Cancer in Bariatric Surgical Patients.
abstract: Oesophageal cancer following bariatric surgery adds significant complexity to an already challenging disease. There is limited data on the diagnosis, presentation and management in these complex cases.
  
  
  
  A retrospective cohort study on prospectively collected data over 10 years was conducted. The oesophago-gastric cancer database was searched for patients with prior bariatric surgery. Data were retrieved on bariatric and cancer management.
  
  
  
  We identified nine patients with oesophageal or gastro-oesophageal junction adenocarcinoma after bariatric surgery. Mean age was 58.3 ± 6.9 years, and duration from bariatric surgery was 13.2 ± 9.4 years. Weight loss at diagnosis was 30.6 ± 23.3 kg (excess weight loss 58.1 % ± 29.6). Modes of presentation were Barrett's surveillance (n = 3), reflux symptoms (n = 4) and incidental (n = 2). Management was surgical resection (n = 4), endoscopic mucosal resection (n = 2) and palliative (n = 3). Surgical resections were challenging due to adhesions, obesity, luminal dilatation and scarring on the stomach. There were two substantial leaks following gastroplasty.
  
  
  
  Oesophageal cancer following bariatric surgery is a challenging problem, and surgical resection carries high risk. A high index of suspicion is required and symptoms investigated precipitously. Technical challenges of operating on obese patients and the specific effects of previous bariatric procedures need to be understood, particularly the limitations on reconstructive options.
authors: Upper Gastrointestinal Surgical Unit, The Alfred Hospital, 99 Commercial Rd, Prahran, 3181, Australia. paul.burton@monash.edu.|Centre for Obesity Research and Education (CORE), Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Prahran, 3181, Australia. paul.burton@monash.edu.
authors: Paul R
authors: PR
authors: Burton
authors: Upper Gastrointestinal Surgical Unit, The Alfred Hospital, 99 Commercial Rd, Prahran, 3181, Australia.|Centre for Obesity Research and Education (CORE), Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Prahran, 3181, Australia.
authors: Geraldine J
authors: GJ
authors: Ooi
authors: Centre for Obesity Research and Education (CORE), Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Prahran, 3181, Australia.
authors: Cheryl
authors: C
authors: Laurie
authors: Upper Gastrointestinal Surgical Unit, The Alfred Hospital, 99 Commercial Rd, Prahran, 3181, Australia.
authors: Kalai
authors: K
authors: Shaw
authors: Upper Gastrointestinal Surgical Unit, The Alfred Hospital, 99 Commercial Rd, Prahran, 3181, Australia.|Centre for Obesity Research and Education (CORE), Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Prahran, 3181, Australia.
authors: Paul E
authors: PE
authors: O'Brien
authors: Upper Gastrointestinal Surgical Unit, The Alfred Hospital, 99 Commercial Rd, Prahran, 3181, Australia.
authors: Andrew
authors: A
authors: Smith
authors: Upper Gastrointestinal Surgical Unit, The Alfred Hospital, 99 Commercial Rd, Prahran, 3181, Australia.
authors: Peter D
authors: PD
authors: Nottle
authors: Upper Gastrointestinal Surgical Unit, The Alfred Hospital, 99 Commercial Rd, Prahran, 3181, Australia.|Centre for Obesity Research and Education (CORE), Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Prahran, 3181, Australia.
authors: Wendy A
authors: WA
authors: Brown
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery*; D000368:Aged; D050110:Bariatric Surgery; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D004943:Esophagogastric Junction / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery; D010166:Palliative Care; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D015431:Weight Loss
keywords: Bariatric surgery; Obesity; Oesophageal neoplasms; Treatment outcome