Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic Sleeve Gastrectomy as a Step Approach for Morbidly Obese Patients with Early Stage Malignancies Requiring Rapid Weight Loss for a Final Curative Procedure

  • Clinical Research
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Laparoscopic sleeve gastrectomy is a relatively new treatment modality implemented in the surgical management for morbid obesity. It has been well documented that obesity is not only associated with an increased risk of malignancies but is also consistent with a higher incidence of surgical complications related to its definitive management. In spite of the weight loss experienced by patients with malignancy due to a catabolic state, bariatric surgery might be considered as a step procedure allowing for a more efficient and suitable surgical approach to treat early stage malignancies, thereby decreasing the procedure-related morbidity and mortality. This study aims to examine the effectiveness of laparoscopic sleeve gastrectomy as a primary weight loss procedure in patients with untreated malignancy facilitating a definitive oncologic surgical approach.

Methods

After institutional review board approval and following Health Insurance Portability and Accountability Act guidelines, we conducted a retrospective review of a prospectively collected database. From September 2006 to March 2009, we analyzed all morbidly obese patients with early stage malignancy that underwent laparoscopic sleeve gastrectomy at the Bariatric and Metabolic Institute as a weight loss surgery prior to a second oncologic procedure. The variables examined were excess body weight, percent excess weight loss, comorbidities, malignancy type, preoperative body mass index (BMI), postoperative BMI, morbidity, and mortality. Mean follow-up time was 3 months until an oncologic procedure was performed.

Results

Our series included four morbidly obese patients. There were three males and one female, with a mean age of 53.75 years (range 27-67 years) and a mean BMI of 48.25 kg/m2 (range 42–55 kg/m2). Mean excess weight in our patient population 176 lbs. Mean weight loss at 3 months after laparoscopic sleeve gastrectomy was 59.35 lbs (range 28–79 lbs). Comorbidities included diabetes mellitus, hypertension, obstructive sleep apnea, chronic obstructive pulmonary disease, Crohn’s disease, coronary artery disease, and previous history of DVT. One patient was diagnosed with a small bowel carcinoid, two patients with renal hypernephroma, and one patient with prostate cancer. After an average time of 3 months, patients underwent a definitive procedure in accordance to their type of malignancy. There were neither postoperative complications nor mortality.

Conclusions

Laparoscopic sleeve gastrectomy is a safe and reasonable approach to effectively reduce weight in order to allow morbidly obese patients with early stage malignancies to undergo a second oncologic procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

BMI:

Body mass index

Fr:

French

LSG:

Laparoscopic sleeve gastrectomy

References

  1. Baltazar A, Serra C, Perez N, et al. Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg. 2005;15(8):1124–8.

    Article  Google Scholar 

  2. Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy, New York City, October 25–27. Obes Surg. 2007;18(5):487–96.

    Article  Google Scholar 

  3. Mognol P, Chosidow D, Marmuse JP. Laparoscopic sleeve gastrectomy: review of a new bariatric procedure and initial results. Surgical Technology International. 2006;15:47–52.

    PubMed  Google Scholar 

  4. Moy J, Pomp A, Parikh M, et al. Laparoscopic sleeve gastrectomy for morbid obesity. Am J Surg. 2008;196(5):56–9.

    Article  Google Scholar 

  5. Cohen R, Uzzan B, Bihan H, et al. Ghrelin levels and sleeve gastrectomy in super-super-obesity. Obes Surg. 2005;15:1024–9.

    Article  Google Scholar 

  6. Frezza EE, Chiriva-Internal M, Wachtel MS. Analysis of the results of sleeve gastrectomy for morbid obesity and the role of ghrelin. Surgery Today. 2008;38(6):481–3.

    Article  PubMed  CAS  Google Scholar 

  7. Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15(7):1024–9.

    Article  PubMed  CAS  Google Scholar 

  8. Roa PE, Kaidar-Person O, Pinto D, et al. (2006) Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short term outcome. Obes Surg. 2006;16:1323–6.

    Article  PubMed  Google Scholar 

  9. Lin E, Gletsu N, Fugate K, et al. The effects of gastric surgery on systemic ghrelin levels in the morbidly obese. Arch Surg. 2004;139:780–4.

    Article  PubMed  Google Scholar 

  10. Tucker O, Szomestein S, Rosenthal R. Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gasttrointest Surg. 2008;12:662–7.

    Article  CAS  Google Scholar 

  11. Merkow R, Bilimoria K, Mc Carter M, et al. Effect of body mass index on short-term outcomes after colectomy for cancer. J Am Coll Surg. 2009;208:53–61.

    Article  PubMed  Google Scholar 

  12. Donohoe C, Pidgeon P, Lysaghjt J, et al. Obesity and gastrointestinal cancer. Br J Surg. 2010;97:628–42.

    Article  PubMed  CAS  Google Scholar 

  13. Molokhia EA, Perkins A. Preventing cancer. Prim Care. 2008;35(4):609–2.

    Article  PubMed  Google Scholar 

  14. Jee SH, Yun JE, Park EJ, et al. Body mass index and cancer risk in Korean men and women. Int J Cancer. 2008;123:1892–6.

    Article  PubMed  CAS  Google Scholar 

  15. Patel AV, Feigelson HS, Talbot JT, et al. The role of body weight in the relationship between physical activity and endometrial cancer: results from a large cohort of US women. Int J Cancer. 2008;123:1877–82.

    Article  PubMed  CAS  Google Scholar 

  16. Jee SH, Kim HJ, Lee J. Obesity, insulin resistance and cancer risk. Yonsei Med J. 2005;46:449–55.

    Article  PubMed  CAS  Google Scholar 

  17. Ruan H, Lodish HF. Regulation of insulin sensitivity by adipose tissue-derived hormones and inflammatory cytokines. Curr Opin Lipidol. 2004;15:297–302.

    Article  PubMed  CAS  Google Scholar 

  18. Christou N, Lieberman M, Sampalis F, et al. Bariatric surgery reduces cancer risk in morbidly obese patients. Surg Obes Relat Dis. 2008;4:691–7.

    Article  PubMed  Google Scholar 

  19. Boru C, Silecchia G, Pecchia A, et al. Prevalence of cancer in Italian obese patients referred for bariatric surgery. Obes Surg. 2005;15:1171–6.

    Article  PubMed  Google Scholar 

  20. Tisdale MJ. Catabolic mediators of cancer cachexia. Curr Opin Support Palliat Care. 2008;2(4):256–61.

    Article  PubMed  Google Scholar 

  21. World Cancer Research Fund. Food, nutrition and the prevention of cancer: a global perspective. Washington: American Institute for Cancer Research; 1997. p. 371–3.

    Google Scholar 

  22. Gendall KA, Raniga S, Kennedy R, et al. The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum. 2007;50:2223–37.

    Article  PubMed  Google Scholar 

  23. Sandeep A, Subhash U, Herron D. Laparoscopic sleeve gastrectomy for morbid obesity: a review. Surg Obes Relat Dis. 2007;3:189–94.

    Article  Google Scholar 

  24. Rubin M, Yehoshua RT, Stein M, et al. Laparoscopic sleeve gastrectomy with minimal morbidity early results in 120 morbidly obese patients. Obes Surg. 2008;18(12):1567–70.

    Article  PubMed  Google Scholar 

  25. Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk superobese patient. Obes Surg. 2004;14:492–7.

    Article  PubMed  Google Scholar 

  26. Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20(6):859–63.

    Article  PubMed  CAS  Google Scholar 

  27. Marceau P, Biron S, Bourque RA, et al. Biliopancreatic diversion with a new type of gastrectomy. Obes Surg. 1993;3:29–35.

    Article  PubMed  Google Scholar 

  28. Ou Yang O, Loi K, Liew V, et al. Staged laparoscopic sleeve gastrectomy followed by Roux-en-Y gastric bypass for morbidly obese patients: a risk reduction strategy. Obes Surg. 2008;18(12):1575–80.

    Article  PubMed  Google Scholar 

  29. Hamoui N, Anthone GJ, Kaufman HS, et al. Sleeve gastrectomy in the high-risk patient. Obes Surg. 2006;16(11):1445–9.

    Article  PubMed  Google Scholar 

  30. Mognol P, Chosidow D, Marmuse J. Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients. Obes Surg. 2005;15:1030–3.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

All authors have no conflicts to disclose.

Author information

Authors and Affiliations

  1. The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL, USA

    Melissa Gianos, Abraham Abdemur, Samuel Szomstein & Raul Rosenthal

  2. Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General and Vascular Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA

    Raul Rosenthal

Authors
  1. Melissa Gianos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abraham Abdemur
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samuel Szomstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raul Rosenthal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Raul Rosenthal.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gianos, M., Abdemur, A., Szomstein, S. et al. Laparoscopic Sleeve Gastrectomy as a Step Approach for Morbidly Obese Patients with Early Stage Malignancies Requiring Rapid Weight Loss for a Final Curative Procedure. OBES SURG 23, 1370–1374 (2013). https://doi.org/10.1007/s11695-013-0933-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-013-0933-z

Keywords

Search

Navigation