Esophagogastric cancer surgery characteristics and outcomes in bariatric patients, compared with non-bariatric patients

BACKGROUND: The association between bariatric surgery and esophagogastric cancer (EGC) is debated. This study aimed to assess EGC characteristics and surgery outcomes comparing bariatric and non-bariatric patients. METHODS: Single-center retrospective analysis of prospective EGC surgery database. RESULTS: EGC-surgery was performed in 269 patients, classified as bariatric (N.=10, 3.3%), and non-bariatric (N.=259, 96.6%) groups. Non-bariatric group was sub-classified into body mass index (BMI) <35 kg/m(2) (N.=244) and >35 kg/m(2) (N.=15). BMI was 35.3 +/- 5.6 vs. 25.7 +/- 16.1 and 37.8 +/- 8.7 kg/m(2) in bariatric vs. non-bariatric-BMI <35 and >35, respectively (P<0.001). Bariatric patients were significantly younger (56.75 +/- 11 vs. 71 +/- 10 and 68.38 +/- 8.2 years; P<0.001). They tended to have lower rates of diabetes mellitus (30% vs. 43.9% and 73.3%; P=0.05) and significantly lower hypertension rates (50%, vs. 86.5% and 93.3%, P<0.004). Bariatric procedures were performed 11.3 years (IQR 5.5-16.5) prior to EGC-surgery. Tumor characteristics were statistically comparable except a significantly higher number of positive LN in the bariatric group (6.9 +/- 13.6 vs. 2.7 +/- 4.9 and 1.9 +/- 4.8; P=0.006), and more bariatric patients received adjuvant treatment (P=0.035). Postoperative major complication rates (0% vs. 25.8%, and 33.3%; P= 0.14) and length of hospital stay (14.1 +/- 15.3, vs. 23 +/- 28.5, and 21 +/- 18 days; P= 0.59) were comparable. There was no significant difference in Disease- free survival (P=0.42) or overall survival (P=0.48) between patient-groups. CONCLUSIONS: Bariatric patients were diagnosed with EGC at a younger age, and tended to have worse nodal involvement. Although outcomes were comparable, clinical and endoscopic surveillance seem important as EGC can occur 10 years or earlier than in non-bariatric patients.