The feasibility and outcomes of metabolic and bariatric surgery prior to neoplastic therapy

Chetan Parmar; Kamal Abi Mosleh; Pauline Aeschbacher; Thorvardur R Halfdanarson; Travis J McKenzie; Raul J Rosenthal; Omar M Ghanem; BRIDGE Study Group

doi:10.1016/j.soard.2024.02.008

The feasibility and outcomes of metabolic and bariatric surgery prior to neoplastic therapy

Surg Obes Relat Dis. 2024 Mar 7:S1550-7289(24)00080-7. doi: 10.1016/j.soard.2024.02.008. Online ahead of print.

Authors

Chetan Parmar¹, Kamal Abi Mosleh², Pauline Aeschbacher³, Thorvardur R Halfdanarson⁴, Travis J McKenzie², Raul J Rosenthal⁵, Omar M Ghanem⁶; BRIDGE Study Group

Collaborators

BRIDGE Study Group:
Helen M Heneghan, Donal J Brennan, Michael Wilkinson, Odhran Ryan, Francesk Mulita, Georgios Ioannis Verras, Emanuele Lo Menzo, Grigorios Christodoulidis, Farah Hussain, Franceso Greco, Rob Snoekx, Pierre B G M Feskens, Tamer N Abdelbaki, Javier Barrionuevo, Asim Shabbir, Simon P L Dexter

Affiliations

¹ Department of Surgery, Whittington Hospital, London, UK; University College London, London, UK.
² Department of Surgery, Mayo Clinic, Rochester, Minnesota.
³ Department of General Surgery and Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
⁴ Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota.
⁵ Department of General Surgery, Bariatric and Metabolic Institute, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida.
⁶ Department of Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: Ghanem.omar@mayo.edu.

PMID: 38594091
DOI: 10.1016/j.soard.2024.02.008

Abstract

Background: 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.

Objectives: 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.

Setting: Multicenter review from twelve tertiary referral centers spanning 8 countries.

Methods: 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.

Results: Thirty-seven patients (median age 52 years, 75.7% female, median BMI of 49.1 kg/m²) 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/m² to 39.7 kg/m² at surgery over an average of 5.8 ± 4.8 months. There were 2 (6.7%) documented mortalities associated with neoplastic surgical intervention.

Conclusions: 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.

Keywords: Bariatric surgery; Cancer surgery; Neoplasia; Obesity and cancer; Sleeve Gastrectomy.