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

Abstract

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. 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 3months until an oncologic procedure was performed. Our series included four morbidly obese patients. There were three males and one female, with a mean age of 53.75years (range 27-67years) and a mean BMI of 48.25kg/m(2) (range 42-55kg/m(2)). Mean excess weight in our patient population 176lbs. Mean weight loss at 3months after laparoscopic sleeve gastrectomy was 59.35lbs (range 28-79lbs). 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 3months, patients underwent a definitive procedure in accordance to their type of malignancy. There were neither postoperative complications nor mortality. 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.