A case of gastric cancer after sleeve gastrectomy.

There is concern over how to survey the remnant upper gastrointestinal tract, as well as what to do if a patient subsequently develops an upper gastrointestinal cancer following bariatric surgery. We hereby report a case of gastric cancer arising 8 years after a laparoscopic sleeve gastrectomy (LSG). The patient, a 42 year-old woman, was diagnosed with a gastric cancer via esophagogastroduodenoscopy (EGD). As such, she underwent a laparoscopic total gastrectomy with lymphadenectomy. The final histopathology was that of a poorly differentiated adenocarcinoma with signet-ring cells without lymph node metastases (staging pT4aN0). The background gastric mucosa displayed no Helicobacter pylori. There have only been a few reported cases of gastric cancer after sleeve gastrectomy. Nevertheless, it may be wise to consider performing EGD at regular intervals after bariatric surgery, especially in Asia. In this regard, LSG holds an advantage over Roux-en-Y gastric bypass with respect to the feasibility of surveillance of the remnant stomach.

Five-year long-term clinical outcome after bariatric metabolic surgery: A multi-ethnic Asian population in Singapore.

Bariatric surgery is an effective treatment for morbid obesity and its metabolic related comorbidities; type 2 diabetes, hypertension and hyperlipidaemia.1 However, the literature is scarce regarding the long-term outcome after bariatric surgery, especially among multi-ethnic Asian populations. Considering the growing number of bariatric metabolic surgeries in Asia, we have attempted to provide a regional perspective on 5-year long-term clinical outcomes post bariatric surgery in Singapore. Between 2010 and 2016, all bariatric operative cases were included, and these comprised: laparoscopic sleeve gastrectomy (LSG), 393; laparoscopic Roux-En-Y gastric bypass (RYGB), 125; laparoscopic mini-gastric bypass (MGB), 43. The primary outcome measure was the percentage of excess weight loss (% EWL) at 6 months, 1, 2, 3, 4 and 5 years, with % remission of type 2 diabetes mellitus (T2DM) at 1 year following LSG (49.7%, 61.2%, 56.1%, 47.8%, 40.8% and 47.3%; 82.2%), RYGB (60.2%, 62.1%, 57.6%, 50.1%, 48.7% and 47.7%; 86.9%) and MGB (58%, 68.1%, 62.7%, 66.2%, 64.0%, 65.2%; 71.9%). In conclusion, MGB and RYGB showed the greatest % EWL at 5 years and are recommended for moderate T2DM. LSG is an effective bariatric operation with a high % EWL up to 2 years, and a high remission rate of mild T2DM. The remission rate of T2DM was equally high in all 3 surgical groups, independent of ethnic differences.