Esophagectomy for Cancer After One Anastomosis Gastric Bypass

One anastomosis gastric bypass (OAGB) is growing in popularity, although it potentially associated with biliary gastritis and gastroesophageal reflux esophagitis, a potential rise esophageal carcinoma. We describe the surgical management of 53-year-old man history OAGB whom adenocarcinoma developed. performed minimally invasive Ivor Lewis esophagectomy, resected sleeved stomach pouch, created new conduit out remnant greater curve blood supply from an intact gastroepiploic artery, esophagogastric anastomosis. This report may guide event that patients develop cancer. The one (OAGB), also referred to as mini bypass, restrictive hypoabsorptive bariatric procedure induce weight loss obesity. It has been gaining popularity since early 2000s, when was first described alternative standard Roux-en-Y bypass1Rutledge R. Kular K. Manchanda N. mini-gastric original technique.Int J Surg. 2019; 61: 38-41Crossref PubMed Scopus (30) Google Scholar by tailoring into long tube (pouch) anastomosed jejunum loop rather than configuration. simplified anatomy this postulated have decreased morbidity (fewer internal hernias, Roux stasis syndrome) bypass.2Chevallier J.M. Arman G.A. Guenzi M. et al.One thousand single (omega loop) bypasses treat morbid obesity 7-year period: outcomes show few complications good efficacy.Obes 2015; 25: 951-958Crossref (166) However, suggested absence allows increased reflux3Keleidari B. Dehkordi M.M. Shahraki M.S. al.Bile after surgery: review study.Ann Med Surg (Lond). 2021; 64102248Google possible increase risk cancers.4Runkel Runkel Esophago-gastric cancer (OAGB).Chirurgia (Bucur). 114: 686-692Crossref (5) unique develops can make performing radical esophagectomy challenging. Here we presentation no before who found mass reflux. A presented our clinic for newly diagnosed adenocarcinoma. His took place 15 years ago involved long, 150-cm omega distal end pouch (Figure 1), vessel 2). He initially outside hospital dysphagia loss. An endoscopic ultrasound examination biopsy specimens revealed presence severe bile causing inflammation Los Angeles grade B esophagitis lower esophagus well 3-cm tumor consistent invasive, poorly differentiated signet ring morphology. staged T3 N1 M0. Immunohistochemistry negative human epidermal growth factor receptor 2 (HER2/neu). programmed cell death ligand 1 combined positive score 5. began neoadjuvant chemotherapy consisting 3 cycles induction leucovorin calcium (folinic acid), fluorouracil, oxaliplatin (FOLFOX). Positron emission tomography scan showed nearly complete metabolic response drop fluorodeoxyglucose 6.7 3.6. multidisciplinary decision made continue 5-fluorouracil during subsequent concurrent radiation (50 Gy 28 fractions). Thrombocytopenia developed, forcing patient skip last week dose oxaliplatin. therapy scarred mucosa visual resolution mass.Figure 2Three-dimensional reconstruction patient’s (A) isolated venous, (B) arterial, (C) vascular bypass. colored pointing-down triangles indicate following: violet, superior mesenteric vein; white, green, artery; yellow, artery.View Large Image Figure ViewerDownload Hi-res image Download (PPT) laparoscopic thoracoscopic esophagectomy. down jejunal segment followed primary reconstruction. placed feeding jejunostomy injected 100 IU Botox pylorus. mediastinal abdominal lymphadenectomy. Finally, ischemically conditioned artery. Once complete, anastomosis, 25-mm OrVil circular stapler (Medtronic), used omental pedicled graft buttress around leak prevent esophagobronchial fistula. Just completion nasogastric without difficulty. Videotaping entire case (Video). specimen sent pathologic evaluation, which 1-mm T1b N0 M0 moderately adenocarcinoma, margins 21 nodes. had uncomplicated postoperative course on Multidisciplinary Esophagectomy Recovery Initiative Team (MERIT) pathway normal findings esophagography 3). eating difficulty doing his 5-month follow-up visit. OAGB, previously thought be controversial procedure, becoming more common because technical demand needed surgeon similarly reasonable outcomes.5Rutledge Walsh T.R. Continued excellent results bypass: six-year study 2,410 patients.Obes 2005; 15: 1304-1308Crossref (230) Hence, see and, consequentially, population patients.6Guirat A. Addossari H.M. cancer.Obes 2018; 28: 1441-1444Crossref (15) makes planning challenging but typically should enable use conduit. prior separation left artery serve ischemic preconditioning, possibly making healthier if were intervention, case. ability spares colon7Kesler K.A. Pillai S.T. Birdas T.J. al.“Supercharged” isoperistaltic colon interposition long-segment reconstruction.Ann Thorac 2013; 95: 1162-1169Abstract Full Text PDF (37) or jejunum,8Gaur P. Blackmon S.H. Jejunal conduits esophagectomy.J Dis. 2014; 6: S333-S340PubMed does not require creation microvascular through “supercharging,”8Gaur thus less complex shorter recovery time. highlights technique patients. Video viewed online version article [https://doi.org/10.1016/j.atssr.2023.03.020] http://www.annalsthoracicsurgery.org.