Oesophageal cancer, obesity and bariatric surgery are increasingly intersecting. Significant obesity and previous bariatric surgery potentially impact the presentation, diagnosis and treatment of oesophageal cancer. There are few reports of oesophageal cancer in bariatric surgical patients and no comparative outcomes studies evaluating how aspects of the disease differ in this population.
The aim of this study was to compare the presentation, diagnosis and treatment outcomes of oesophageal cancer among bariatric patients with non-bariatric patients as controls.
We performed a retrospective case-control study from a prospectively maintained database of oesophageal cancer patients from the Alfred Hospital (Melbourne, Victoria, Australia). We compared the outcomes among bariatric patients against non-bariatric cancer patients as control in a 1:5 ratio.
We identified 15 oesophageal cancer patients following bariatric surgery, and from 413 non-bariatric oesophageal cancer patients, 95 patients were selected as control. 13 (86.7%) bariatric patients had adjustable gastric band prior to oesophageal cancer. When diagnosed with oesophageal cancer, bariatric patients tend to be younger (62.20 years ± 10.16 vs 68.52 ± 9.10, p=0.0191) and greater in weight (127.0 kg (95.50 – 147.3) vs 73.00 (61.30 – 90.00), p<0.0001). Bariatric patients were less likely to obtain curative management plan for their oesophageal cancer treatment (66.67% vs 87.37%, p=0.0393). Furthermore, compared to controls, bariatric patients had higher complication rates (100% vs 53.73%, p=0.0438) and longer length of stay (44.00 days (1.00 – 81.00) vs 16.00 (12.00 – 20.25)). Anastomotic leak was a prominent complication among bariatric patients (60% vs 19.44%, p=0.0478).
Oesophageal cancer in bariatric surgical patients is a major challenge, demonstrating complicated cancer outcomes. Despite being younger, bariatric patients were less likely to undergo a curative treatment pathway. Moreover, surgical complications were markedly higher in rates. Therefore, follow-up following bariatric surgery is an important aspect to prevent unwanted complications, such as oesophageal cancer.