Belhaj A, Memmo L, Mehdi A, Mboti F, Closset J
Hôpital Erasme, Services de Chirurgie Digestive, Bruxelles.
Rev Med Brux. 2010 Sep-Oct;31(5):459-62.
Bariatric surgery is considered as the most effective therapy for morbid obesity. But, each procedure carries both short-and long-term complications. And, it remains unclear if the late occurrence of gastric adenocarcinoma could be linked to bariatric surgery. We described a case of a female who developed a gastric adenocarcinoma after a silastic ring vertical gastroplasty (SRVG).
A 54-year-old female presented with postprandial vomiting, poor appetite, dysphagia and weight loss 10 year after a SRVG. A gastroscopy with biopsy disclosed a juxta-pyloric adenocarcinoma. No distant metastasis was found. After 3 cycles of neoadjuvant chemotherapy, a subtotal gastrectomy with Roux-en-Y anastomosis was performed.
After the surgery, a minor anastomotic leak was treated conservatively and a parietal abscess was drained. The pathological studies demonstrated a T2bN1 adenocarcinoma with negative margins. Adjuvant chemotherapy was administered. At the last work up, the patient is disease-free.
The association between a gastric adenocarcinoma and a bariatric procedure such as a SRVG is difficult to assess without a case-control or a cross-sectional study. Nevertheless, when new upper digestive tract complaints occur in any patient with an otherwise unremarkable bariatric surgery follow-up, the diagnosis of gastric cancer should be bear in mind.
减肥手术被认为是治疗病态肥胖最有效的方法。但是，每种手术都有短期和长期并发症。而且，胃腺癌的晚期发生是否与减肥手术有关仍不清楚。我们描述了一例女性患者，她在接受硅橡胶环垂直胃成形术（SRVG）后发生了胃腺癌。
一名54岁女性在接受SRVG 10年后出现餐后呕吐、食欲不振、吞咽困难和体重减轻。胃镜检查及活检发现胃幽门旁腺癌。未发现远处转移。经过3个周期的新辅助化疗后，进行了胃大部切除术并 Roux-en-Y 吻合术。
术后，一个较小的吻合口漏通过保守治疗，一个壁层脓肿被引流。病理研究显示为 T2bN1 腺癌，切缘阴性。给予辅助化疗。在最后一次检查时，患者无疾病。
在没有病例对照或横断面研究的情况下，很难评估胃腺癌与诸如 SRVG 等减肥手术之间的关联。然而，当任何减肥手术随访过程中无其他异常的患者出现新的上消化道症状时，应考虑胃癌的诊断。
