Affiliation:
1. Medical Center AVICENNA; Novosibirsk State Medical University
2. Medical Center AVICENNA; Clinical Hospital “Russian Railways-Medicine»
3. Novosibirsk State Medical University
4. “Veсtor-Best»; Institute of Molecular and Cellular Biology of the Siberian Department of the Russian Academy of Sciences
Abstract
Introduction: Gastric cancer is one of the most common oncological diseases in the world, occupying the 5th place of morbidity and the 3rd place in the structure of mortality from oncological diseases. For a long time, issues affecting the risk of developing cancer after bariatric surgery remain relevant. Our observation is devoted to the diagnosis and treatment of a patient with gastric cancer after gastric bypass. Description of the clinical case: A 62‑year‑old patient was operated on 13. 07. 2016 – laparoscopic Roux gastric bypass for morbid obesity, 11. 09. 2019 – laparoscopic installation of the Cardioplant plate on a small stomach due to recurrent weight gain. Since 2020 the patient had the phenomena of anastomositis, dysphagia and gastroesophageal reflux. Courses of conservative therapy, sessions of balloon dilation of gastroenteroanastomosis and anastomosis resection failed to show a significant effect. The patient underwent comprehensive examinations at each treatment, including abdominal MSCT, cancer markers and studies of biopsy material of the gastric mucosa and gastroenteroanastomosis. As a result of histological studies, no signs of cancer were found. After applying to the Avicenna Medical Center in 2022 a molecular genetic analysis was carried out, in which the mRNA panel most corresponded to a malignant neoplasm. 20. 12. 2022 extirpation of the stomach stump with resection of the esophagus was performed. The cancer diagnosis was confirmed by histological and immunohistochemical studies: low‑grade adenocarcinoma of the stomach with a cricoid component with germination into the esophagus and small intestine, with spread beyond the muscle layer. Conclusion: This clinical case highlights the complexity of oncological verification in patients after bariatric surgery. Prolonged dysphagia, anastomositis and recurrent GERD in such patients determine the need for a more detailed examination, including the latest achievements of molecular genetic analysis.
Publisher
Russian Society of Clinical Oncology
Reference17 articles.
1. Sung H., Ferlay J., Siegel R.L., et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71(3):209–249. doi: 10.3322/caac.21660
2. The state of oncological care to the population of Russia in 2021. Eds.: А.D. Kaprin, V.V. Starinskiy, A.O. Shachzadova. Moscow: MNIOI im. P.A. Gertsena – filial FGBU “NMITS radiologii” Minzdrava Rossii, 2022.239 p. (in Russ.).
3. Malignant tumors in Russia in 2021 (morbidity and mortality). Eds.: А.D. Kaprin, V.V. Starinskiy, A.O. Shachzadova. Moscow: MNIOI im. P.A. Gertsena – filial FGBU “NMITS radiologii” Minzdrava Rossii, 2022.252 p. (In Russ.)
4. Adams T.D., Meeks H., Fraser A., et al. Long‑term all‑cause and cause‑specific mortality for four bariatric surgery procedures. Obesity (Silver Spring) 2023;31(2):574–585. doi: 10.1002/oby.23646
5. Aminian A., Wilson R., Al‑Kurd A., et al. Association of bariatric surgery with cancer risk and mortality in adults with obesity. JAMA 2022;327(24):2423–2433. doi: 10.1001/jama.2022.9009