Department of Surgery, Whittington Hospital, London, UK; University College London, London, UK.
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Surg Obes Relat Dis. 2024 Aug;20(8):717-728. doi: 10.1016/j.soard.2024.02.008. Epub 2024 Mar 7.
Metabolic and bariatric surgery (MBS) is a potent intervention for addressing obesity-related medical conditions and achieving sustainable weight loss. Beyond its conventional role, MBS has demonstrated potential to serve as a transitional step for patients requiring various interventions. However, the implications of MBS in the context of neoplasia remain understudied.
To explore the feasibility of MBS as a possible attempt to reduce surgical and treatment risks in patients with benign tumors or low-grade cancers.
Multicenter review from twelve tertiary referral centers spanning 8 countries.
A retrospective review of patients with a diagnosis of primary neoplasia, deemed inoperable or high-risk due to obesity, and receiving primary MBS prior to neoplastic therapy. Data encompassed baseline characteristics, neoplasia characteristics, MBS outcomes, and neoplastic therapy outcomes.
Thirty-seven patients (median age 52 years, 75.7% female, median BMI of 49.1 kg/m) were included. There were 9 distinct organs of origin of primary neoplasia, with the endometrium (43.2%) being the most common, followed by the pancreas, colon, kidney and breast. Sleeve gastrectomy (SG) was the most commonly performed MBS procedure (78.4%), with no MBS-related complications or mortalities reported over an average of 4.3 ± 3.9 years. Thirty-one patients (83.8%) eventually underwent neoplastic surgery, with a mean BMI decrease from 49.9 kg/m to 39.7 kg/m at surgery over an average of 5.8 ± 4.8 months. There were 2 (6.7%) documented mortalities associated with neoplastic surgical intervention.
This study highlights the potential feasibility of employing MBS prior to neoplastic therapy in patients with low-grade, less aggressive neoplasms in the context of obesity. This underscores the importance of providing a personalized, case-to-case multidisciplinary approach in the management of these patients.
代谢和减重手术（MBS）是一种有效的干预措施，可用于解决肥胖相关的医疗状况并实现可持续的体重减轻。除了其传统作用外，MBS 已显示出作为需要各种干预措施的患者的过渡步骤的潜力。然而，MBS 在肿瘤学背景下的意义仍在研究中。
探讨 MBS 作为一种可能的尝试，以降低肥胖患者良性肿瘤或低级别癌症患者的手术和治疗风险。
来自 8 个国家的 12 个三级转诊中心的多中心回顾。
回顾性分析诊断为原发性肿瘤的患者，由于肥胖而被认为无法手术或高风险，并在肿瘤治疗前接受原发性 MBS。数据包括基线特征、肿瘤特征、MBS 结果和肿瘤治疗结果。
纳入 37 名患者（中位年龄 52 岁，75.7%为女性，中位 BMI 为 49.1kg/m²）。原发性肿瘤的起源器官有 9 个，子宫内膜（43.2%）最常见，其次是胰腺、结肠、肾脏和乳房。胃袖状切除术（SG）是最常进行的 MBS 手术（78.4%），平均随访 4.3±3.9 年后无 MBS 相关并发症或死亡率。31 名患者（83.8%）最终接受了肿瘤手术，平均 BMI 从 49.9kg/m²降至 39.7kg/m²，平均手术时间为 5.8±4.8 个月。有 2 例（6.7%）与肿瘤手术干预相关的死亡。
本研究强调了在肥胖患者中，对于低度、侵袭性较低的肿瘤，在肿瘤治疗前使用 MBS 的潜在可行性。这突显了在这些患者的管理中提供个性化、病例到病例的多学科方法的重要性。
