Metabolic and bariatric surgery (MBS) offers a promising role as a transformative procedure prior to neoplastic therapy for patients afflicted with both obesity and low-grade, less aggressive neoplasms, according to a study, ‘The feasibility and outcomes of metabolic and bariatric surgery prior to neoplastic therapy’, published in SOARD on behalf of the BRIDGE Study Group.
Lead-author of the study, Dr Chetan Parmar (Department of Surgery, Whittington Hospital and University College London, London, UK) and his team designed the study to examine the feasibility of employing MBS - prior to neoplastic therapy - in a select group of patients who were initially deemed inoperable or high-risk due to a high body mass index (BMI). The researchers conducted a retrospective, multicentre study of all patients with a diagnosed neoplasm who were initially deemed at high risk for cancer surgery due to obesity (BMI>35 kg/m2). This study is first of its kind to look at role of MBS to facilitate cancer surgery.
After referral for weight loss intervention, the type of MBS offered as well as patient weight at time of surgery, weight at three, six and 12 months postoperatively and any complications related to the procedure were recorded. The researchers also recorded the approach to neoplastic therapy (surgical and nonsurgical) interventions, associated complications, utilisation of neoadjuvant/adjuvant therapy and the conclusive TNM staging.
Outcomes
In total, 37 patients (28 female, 75.7%) from twelve different medical centres from eight countries were diagnosed with a neoplasm and were deemed at very high risk for intervention due to excessive weight and were subsequently referred for MBS. Associated medical conditions included hypertension (51.4%), diabetes mellitus (40.5%) and obstructive sleep apnoea (24.3%).
Nine different organs were involved. The endometrium was the most common source of diagnosed neoplasia (43.2%), followed by the pancreas (16.2%), colon and rectum(16.2%), kidney (8.2%) and breast (5.4%). There were eight (21.6%) benign tumours and 29 (78.4%) neoplasms represented invasive cancers.
The average duration between the diagnosis of neoplasia and MBS was 9 months. Among the MBS procedures performed, sleeve gastrectomy (SG) was the most common (29 cases, 78.4%), followed by Roux-en-Y gastric bypass and one anastomosis gastric bypass (four cases each, 10.8%). Median BMI decreased significantly at 3 months (42.6 kg/m2), 6 months (36.4 kg/m2) and 12 months (33.5kg/m2) postoperatively, resulting in a total weight loss of 16.4%, 24.2% and 31.3% respectively (p<0.001). The mean drop in BMI was around 10.2 units.
There were no reported early (<30 days) or late (>30days) significant complications in any of the patients who had undergone MBS over a total follow-up period of 4.3+3.9 years. There was 0% mortality associated with MBS.
Thirty-one patients (83.8%) underwent surgical treatment for neoplasia following MBS. Neoadjuvant anti-neoplastic therapy was administered to fifteen patients (40.5%). In the remaining six cases (five endometrial adenocarcinomas and one neuroendocrine tumour of small bowel) hormonal therapy was utilised to manage their neoplasia.
The mean time from MBS to neoplastic surgical intervention was approximately 5.8 months. The average time duration between neoplasia diagnosis and ultimate surgical treatment of neoplasia was 14.5+18.7 months. Some post-neoplastic surgery complications arose on the short-term (<30 days) including two cases of surgery-related bleeding necessitating transfusion, a urinary tract infection, a surgical site infection and a Clostridium difficile infection.
There were two (6.5%) documented mortalities following neoplastic surgery including gone case of haemorrhagic shock following left colectomy for colon adenocarcinoma (7 days postoperatively) and one case following radical nephrectomy without a documented cause of death (five years postoperatively).
“MBS effectively led to substantial reductions in BMI, with sleeve gastrectomy emerging as the most common choice, primarily due to its efficacy and favourable risk profile,” the paper’s authors concluded. “This offers a promising avenue for providing a personalized, case-to-case approach to these patients after thorough consultations with relevant MDTs.”
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