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Obesity Surgery

, Volume 19, Issue 3, pp 385–388 | Cite as

Morbid Obesity and Subsequent Pancreatic Cancer: Pylorus-Preserving Pancreatoduodenectomy after Laparoscopic Sleeve Gastrectomy

  • Markus A. KüperEmail author
  • Ingmar Königsrainer
  • Diethard Schmidt
  • K. Michael Kramer
  • Frank A. Granderath
  • Joachim Schneider
  • Stefan Löb
  • Derek Zieker
  • Jörg T. Hartmann
  • Marty Zdichavsky
  • Alfred Königsrainer
  • Björn L. D. M. Brücher
Case Report

Abstract

Morbid obesity is a recognized risk factor for gastrointestinal cancer. Little is known about pancreatic cancer developing after gastric bypass surgery or about surgery for this type of tumor following bariatric surgery. This report describes a case of pancreatic head cancer identified 3 months after laparoscopic sleeve gastrectomy for morbid obesity. During routine follow-up, mild abdominal pain and elevated pancreatic enzymes prompted computed tomography, which revealed mild edematous pancreatitis. Hyperbilirubinemia developed, and magnetic resonance imaging showed a pancreatic head tumor. CA19-9 was elevated. After a pylorus-preserving pancreatic head resection, the postoperative course was uneventful. The patient received adjuvant chemotherapy. Unfortunately, at the time of writing (9 months postoperatively), a local recurrence and hepatic metastases were diagnosed. Patients treated with bariatric surgery who develop new symptoms or report constant mild symptoms should be evaluated using endoscopy and radiomorphological imaging. Interdisciplinary obesity treatment can then offer significant benefits for the patient, particularly in the case of pancreatic cancer, which is still difficult to diagnose. In addition, there is a need for epidemiological studies of patients who undergo bariatric surgery and subsequently develop cancer.

Keywords

Pancreatic cancer Morbid obesity Bariatric surgery Pancreatoduodenectomy Sleeve gastrectomy 

References

  1. 1.
    Lord RV, Edwards PD, Coleman MJ. Gastric cancer in the bypassed segment after operation for morbid obesity. Aust N Z J Surg. 1997;67:580–2.CrossRefGoogle Scholar
  2. 2.
    Raijman I, Strother SV, Donegan WL. Gastric cancer after bypass for obesity. Case report. J Clin Gastroenterol. 1991;13:191–4.CrossRefGoogle Scholar
  3. 3.
    Trincado MT, del Olmo JC, Garcia Castaño J, et al. Gastric pouch carcinoma after gastric bypass for morbid obesity. Obes Surg. 2005;15:1215–7.CrossRefGoogle Scholar
  4. 4.
    Escalona A, Guzman S, Ibanez L, et al. Gastric cancer after Roux-en-Y gastric bypass. Obes Surg. 2005;15:423–7.CrossRefGoogle Scholar
  5. 5.
    Babor R, Booth M. Adenocarcinoma of the gastric pouch 26 years after loop gastric bypass. Obes Surg. 2006;16:935–8.CrossRefGoogle Scholar
  6. 6.
    Allen JW, Leeman MF, Richardson JD. Esophageal carcinoma following bariatric procedures. JSLS 2004;8:372–5.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Kueper MA, Kramer KM, Kirschniak A, et al. Laparoscopic sleeve gastrectomy: standardized technique of a potential stand-alone bariatric procedure in morbidly obese patients. World J Surg. 2008;32:1462–5.CrossRefGoogle Scholar
  8. 8.
    Pezzilli R, Morselli-Labate AM, Migliori M, et al. Obesity and the risk of pancreatic cancer: an Italian multicenter study. Pancreas 2005;31:221–4.CrossRefGoogle Scholar
  9. 9.
    Patel AV, Rodriguez C, Bernstein L, et al. Obesity, recreational physical activity, and risk of pancreatic cancer in a large U.S. cohort. Cancer Epidemiol Biomarkers Prev. 2005;14:459–66.CrossRefGoogle Scholar
  10. 10.
    Berrington de Gonzalez A, Sweetland S, Spencer E. A meta-analysis of obesity and the risk of pancreatic cancer. Br J Cancer. 2003;89:519–23.CrossRefGoogle Scholar
  11. 11.
    DeMaria EJ. Bariatric surgery for morbid obesity. N Engl J Med. 2007;356:2176–83.CrossRefGoogle Scholar
  12. 12.
    Weiner RA, Pomhoff I, Schramm M, et al. New advances in laparoscopic treatment of morbid obesity. Surg Technol Int. 2004;13:79–90.PubMedGoogle Scholar
  13. 13.
    Marceau P, Biron S, Bourque RA, et al. Biliopancreatic diversion with a new type of gastrectomy. Obes Surg. 1993;3:29–35.CrossRefGoogle Scholar
  14. 14.
    Frezza EE. Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice? Surg Today. 2007;37:275–81.CrossRefGoogle Scholar
  15. 15.
    Roa PE, Kaidar-Person O, Pinto D, et al. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006;16:1323–6.CrossRefGoogle Scholar
  16. 16.
    Mognol P, Chosidow D, Marmuse JP. Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients. Obes Surg. 2005;15:1030–3.CrossRefGoogle Scholar
  17. 17.
    Aggarwal S, Kini SU, Herron D. Laparoscopic sleeve gastrectomy for morbid obesity: a review. Surg Obes Relat Dis. 2007;3:189–94.CrossRefGoogle Scholar
  18. 18.
    Weiner RA, Weiner S, Pomhoff I, et al. Laparoscopic sleeve gastrectomy—influence of sleeve size and resected gastric volume. Obes Surg. 2007;17:1297–305.CrossRefGoogle Scholar
  19. 19.
    Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16:1450–6.CrossRefGoogle Scholar
  20. 20.
    Roberts K, Duffy A, Kaufman J, et al. Size matters: gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21:1397–402.CrossRefGoogle Scholar
  21. 21.
    Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15:1024–9.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Markus A. Küper
    • 1
    Email author
  • Ingmar Königsrainer
    • 1
  • Diethard Schmidt
    • 2
  • K. Michael Kramer
    • 1
  • Frank A. Granderath
    • 1
  • Joachim Schneider
    • 1
  • Stefan Löb
    • 1
  • Derek Zieker
    • 1
  • Jörg T. Hartmann
    • 3
  • Marty Zdichavsky
    • 1
  • Alfred Königsrainer
    • 1
  • Björn L. D. M. Brücher
    • 1
  1. 1.Department of General, Visceral, and Transplantation Surgery, Comprehensive Cancer CenterUniversity of TübingenTübingenGermany
  2. 2.Department of Diagnostic and Interventional Radiology, Comprehensive Cancer CenterUniversity of TübingenTübingenGermany
  3. 3.Department of Oncology, Comprehensive Cancer CenterUniversity of TübingenTübingenGermany

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