Raghavendra Rao S, Kini Dr
Division of Metabolic Endocrine and Minimally Invasive Surgery, Mount Sinai Medical Center, NY, New York, USA.
JSLS. 2012 Jul-Sep;16(3):360-72. doi: 10.4293/108680812X13462882736457.
Obesity is associated with several comorbidities like diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea. It is also well established that obese patients have an increased risk of several types of cancer like kidney, pancreas, endometrial, breast, and others. The bariatric surgeon needs to be aware of the problem of benign tumors and cancer in obese patients as well as the optimal management of these conditions that may be present at the time of evaluation for bariatric surgery, during the surgical procedure, and in the postoperative period.
A PubMed search for the words "cancer" and "bariatric surgery" and subsequent review of the abstracts identified 40 articles concerning cancerous, benign, and premalignant conditions in bariatric surgery patients. Data were then extracted from full-text articles.
Bariatric surgery decreases cancer risk especially in women. RYGB can be an effective treatment for Barrett's esophagus. Patients having esophageal cancer should not undergo bariatric surgery, while those who develop the same postoperatively are usually managed by a combined abdominal and thoracic approach (Ivor Lewis technique). Gastric cancer of the remnant stomach is usually managed by a remnant gastrectomy. A remnant gastrectomy during RYGB would be necessary in conditions that require endoscopic surveillance of the stomach like gastric polyps, intestinal metaplasia, and carcinoid tumors. Sleeve gastrectomy is an excellent option in a patient with GIST or a carcinoid who needs a bariatric operation. Preoperative endoscopy usually does not detect malignant conditions. Postoperative evaluation of the bypassed stomach is possible using various percutaneous and novel endoscopic techniques.
肥胖与多种合并症相关，如糖尿病、高血压、高脂血症和阻塞性睡眠呼吸暂停。肥胖患者患几种类型癌症的风险增加，如肾癌、胰腺癌、子宫内膜癌、乳腺癌等，这一点也已得到充分证实。减重外科医生需要了解肥胖患者的良性肿瘤和癌症问题，以及在减重手术评估时、手术过程中和术后可能出现的这些情况的最佳管理方法。
在PubMed上搜索“癌症”和“减重手术”，随后对摘要进行审查，确定了40篇关于减重手术患者的癌性、良性和癌前病变情况的文章。然后从全文文章中提取数据。
减重手术可降低癌症风险，尤其是在女性中。Roux-en-Y胃旁路术（RYGB）可有效治疗巴雷特食管。患有食管癌的患者不应接受减重手术，而术后发生食管癌的患者通常采用腹部和胸部联合手术方法（艾弗·刘易斯技术）进行治疗。残胃癌通常采用残胃切除术治疗。在需要对胃进行内镜监测的情况下，如胃息肉、肠化生和类癌肿瘤，RYGB手术期间进行残胃切除术是必要的。对于需要进行减重手术的胃肠道间质瘤（GIST）或类癌患者，袖状胃切除术是一个很好的选择。术前内镜检查通常无法检测到恶性病变。可使用各种经皮和新型内镜技术对旷置胃进行术后评估。
