Skip to main content
SpringerLink
Log in

Laparoscopic Sleeve Gastrectomy as a First Step Procedure for Oncologic Purposes: An Indication Beyond the Updated Guidelines

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Obesity is a well-established risk factor for cancer. Laparoscopic sleeve gastrectomy (LSG) is established as a safe procedure providing accelerated weight loss and comorbidity improvement or remission. Additionally, it is approved as a bridging procedure for various non-oncologic surgeries, with very limited data for oncologic procedures. The aim of this study is to present a series of patients with severe obesity and concomitant cancer who underwent LSG prior to definitive oncological procedure.

Methods

A retrospective review (2008–2023) was conducted in three institutions, identifying 5 patients with cancer and severe obesity who underwent LSG as bridging procedure. Variables analyzed were initial weight, initial body mass index (BMI), type of malignancy, comorbidities, interval between LSG and oncological surgery, weight and BMI before the second intervention, percentage of excess weight loss (%EWL), and postoperative morbidity and mortality.

Results

Malignancies identified were 2 prostate cancers, 1 periampullary neuroendocrine tumor, 1 rectal cancer, and 1 renal clear cell carcinoma. Mean age of patients was 50.2 years, mean initial BMI 47.4 kg/\({{\text{m}}}^{2}\), and mean BMI before oncological surgery 37 kg/\({{\text{m}}}^{2}\). Mean time interval between LSG and oncological surgery was 8.3 months. Mean %EWL achieved was 45.2%. Two thromboembolic events were encountered after LSG, while none of the patients developed complications after definitive oncological treatment. The mean follow-up after oncological surgery was 61.6 months.

Conclusion

LSG can be proposed as bridging procedure before oncological surgery in meticulously selected patients. Achieved weight loss can render subsequent oncological procedures easier and safer.

Graphical Abstract

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

Fig. 1

Similar content being viewed by others

Data Availability

The data that support the findings of this study are available upon request from the corresponding authors (Rodrigue Chemaly, Claude Tayar and Bassem Safadi).

References

  1. Iyengar NM, Gucalp A, Dannenberg AJ, et al. Obesity and cancer mechanisms: tumor microenvironment and inflammation. J Clin Oncol. 2016;34(35):4270–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Avgerinos KI, Spyrou N, Mantzoros CS, et al. Obesity and cancer risk: emerging biological mechanisms and perspectives. Metabolism. 2019;92:121–35.

    Article  CAS  PubMed  Google Scholar 

  3. Calle EE, Rodriguez C, Walker-Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348(17):1625–38.

    Article  PubMed  Google Scholar 

  4. Dharap SB, Barbaniya P, Navgale S. Incidence and risk factors of postoperative complications in general surgery patients. Cureus. 2022;14(11):e30975.

    PubMed  PubMed Central  Google Scholar 

  5. Plassmeier L, Hankir MK, Seyfried F. Impact of excess body weight on postsurgical complications. VIS. 2021;37(4):287–97.

    Google Scholar 

  6. Salminen P, Grönroos S, Helmiö M, et al. Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss, comorbidities, and reflux at 10 years in adult patients with obesity: the SLEEVEPASS randomized clinical trial. JAMA Surg. 2022;157(8):656–66.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg. 1998;8(3):267–82.

    Article  CAS  PubMed  Google Scholar 

  8. Regan JP, Inabnet WB, Gagner M, et al. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg. 2003;13(6):861–4.

    Article  CAS  PubMed  Google Scholar 

  9. Eisenberg D, Bellatorre A, Bellatorre N. Sleeve gastrectomy as a stand-alone bariatric operation for severe, morbid, and super obesity. JSLS. 2013;17(1):63–7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis. 2022;18(12):1345–56.

    Article  PubMed  Google Scholar 

  11. 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. 2013;23(9):1370–4.

    Article  PubMed  Google Scholar 

  12. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49.

    Article  PubMed  Google Scholar 

  13. Obesity and overweight [Internet]. [cited 2023 Aug 14]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed Sep 2023

  14. Chemaly R, Nakhle M. Obesity and cancer: two sides of the same coin. Obes Surg. 2023;33(7):2253–4.

    Article  PubMed  Google Scholar 

  15. Pati S, Irfan W, Jameel A, et al. Obesity and cancer: a current overview of epidemiology, pathogenesis, outcomes, and management. Cancers. 2023;15(2):485.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Grönroos S, Helmiö M, Juuti A, et al. Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss and quality of life at 7 years in patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA Surg. 2021;156(2):137–46.

    Article  PubMed  Google Scholar 

  17. Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg. 2003;13(3):329–30.

    Article  PubMed  Google Scholar 

  18. Zhou Y, Wu L, Li X, et al. Outcome of laparoscopic colorectal surgery in obese and nonobese patients: a meta-analysis. Surg Endosc. 2012;26(3):783–9.

    Article  PubMed  Google Scholar 

  19. Hussan H, Gray DM, Hinton A, et al. Morbid obesity is associated with increased mortality, surgical complications, and incremental health care utilization in the peri-operative period of colorectal cancer surgery. World J Surg. 2016;40(4):987–94.

    Article  PubMed  Google Scholar 

  20. Gabriel RA, Hylton DJ, Burton BN, et al. The association of preoperative haemoglobin A1c with 30-day postoperative surgical site infection following non-cardiac surgery. J Perioper Pract. 2019;30(10):320–5.

    PubMed  Google Scholar 

  21. Blokhin IO, Lentz SR. Mechanisms of thrombosis in obesity. Curr Opin Hematol. 2013;20(5):437–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Li S, Luo X, Sun H, et al. Does prior bariatric surgery improve outcomes following total joint arthroplasty in the morbidly obese? A meta-analysis. J Arthroplast. 2019;34(3):577–85.

    Article  Google Scholar 

  23. Dowsey MM, Brown WA, Cochrane A, et al. Effect of bariatric surgery on risk of complications after total knee arthroplasty: a randomized clinical trial. JAMA Netw Open. 2022;5(4):e226722.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Fernando S, Varma J, Dengu F, et al. Bariatric surgery improves access to renal transplantation and is safe in renal failure as well as after transplantation: a systematic review and meta-analysis. Transplant Rev (Orlando). 2023;37(3):100777.

    Article  PubMed  Google Scholar 

  25. Yemini R, Nesher E, Braun M, et al. Long-term outcomes of Roux-en-Y gastric bypass or sleeve gastrectomy in patients with cirrhosis; before, during or after liver transplantation: a single center’s experience. Clin Transplant. 2021;35(8):e14374.

    Article  PubMed  Google Scholar 

  26. Lee Y, Tian C, Lovrics O, et al. Bariatric surgery before, during, and after liver transplantation: a systematic review and meta-analysis. Surg Obes Relat Dis. 2020;16(9):1336–47.

    Article  PubMed  Google Scholar 

  27. Lee Y, Anvari S, Sam Soon M, et al. Bariatric surgery as a bridge to heart transplantation in morbidly obese patients: a systematic review and meta-analysis. Cardiol Rev. 2022;30(1):1–7.

    Article  PubMed  Google Scholar 

  28. Lim CP, Fisher OM, Falkenback D, et al. Bariatric surgery provides a ‘bridge to transplant’ for morbidly obese patients with advanced heart failure and may obviate the need for transplantation. Obes Surg. 2016;26(3):486–93.

    Article  PubMed  Google Scholar 

  29. Abu Zaanona MI, Mantha S. Cancer-associated thrombosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Aug 1]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK562222/. Accessed Sep 2023

  30. Hotoleanu C. Association between obesity and venous thromboembolism. Med Pharm Rep. 2020;93(2):162–8.

    PubMed  PubMed Central  Google Scholar 

  31. Felsenreich DM, Ladinig LM, Beckerhinn P, et al. Update: 10 years of sleeve gastrectomy—the first 103 patients. Obes Surg. 2018;28(11):3586–94.

    Article  PubMed  Google Scholar 

  32. Aminian A, Vosburg RW, Altieri MS, et al. The American Society for Metabolic and Bariatric Surgery (ASMBS) updated position statement on perioperative venous thromboembolism prophylaxis in bariatric surgery. Surg Obes Relat Dis. 2022;18(2):165–74.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon

    Rodrigue Chemaly, Zeid Ibrahim, Makram Abou Ghaida & Nadim El Kassir

  2. Department of General Surgery, Lebanese American University Medical Center – Rizk Hospital, LAU Gilbert and Rose-Marie Chagoury School of Medicine, Beirut, Lebanon

    Rodrigue Chemaly, Zeid Ibrahim, Nadim El Kassir & Georges Al-Hajj

  3. Department of Minimally Invasive Digestive & Bariatric Surgery, Metropolitan Hospital, Athens, Greece

    Panagiotis Lainas

  4. Department of Surgery, Clemenceau Medical Center, Beirut, Lebanon

    Claude Tayar

  5. Department of Surgery, Aman Hospital, Doha, Qatar

    Bassem Safadi

Authors
  1. Rodrigue Chemaly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zeid Ibrahim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Panagiotis Lainas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Makram Abou Ghaida
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nadim El Kassir
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Georges Al-Hajj
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Claude Tayar
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bassem Safadi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rodrigue Chemaly.

Ethics declarations

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study formal consent is not required.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key Points

• Obesity is a risk factor for cancer and increases the rate of complications after surgery.

• Laparoscopic sleeve gastrectomy (LSG) is established as safe and effective method for accelerated weight loss.

• LSG is approved as bridging procedure before transplantation, arthroplasty, and hernia surgeries.

• LSG can be proposed as a bridging procedure before oncological surgery in meticulously selected patients.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chemaly, R., Ibrahim, Z., Lainas, P. et al. Laparoscopic Sleeve Gastrectomy as a First Step Procedure for Oncologic Purposes: An Indication Beyond the Updated Guidelines. OBES SURG 34, 2026–2032 (2024). https://doi.org/10.1007/s11695-024-07257-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-024-07257-7

Keywords

Search

Navigation