Esophageal cancer surgery not affected by obesity

Obese patients who undergo surgery for esophageal cancer with a procedure called transhiatal esophagectomy appear to fare just as well as their normal weight counterparts, according to study findings presented Tuesday at the Society of Thoracic Surgeons annual meeting in San Diego.

In the last 20 years, the most common cell type involved in esophageal cancer in the U.S. has changed. Most of these cancers were composed of squamous cell carcinomas, cells derived from the middle layer of skin. But now, 85 percent of esophageal cancers are adenocarcinomas, cells that originate from the lining of certain organs.

Researchers believe this is due, in large part, to the rising obesity epidemic, since adenocarcinoma is related to gastroesophageal reflux, or "GERD," which, in turn, is associated with obesity.

Transhiatal esophagectomy, which avoids the longer recovery time required after a chest incision, approaches the esophagus through the abdomen, and typically takes longer to perform in obese patients.

The current study findings indicate that the longer procedural time does not translate into an increase in hospital length of stay, more complications or a higher death rate.

However, comparable outcomes in obese patients may not be attained at all hospitals -- the key is experience. As senior investigator Dr. Mark Orringer told Reuters Health, "this is an operation that needs to be performed at high-volume centers by experienced surgeons."

He added that at his center, the University of Michigan Health System in Ann Arbor, "we've even developed special instruments for use in obese patients."

Orringer's group compared the outcomes of 133 profoundly obese patients, with a body mass index of more than 34 (normal BMI ranges from the low to mid 20s) and 133 non-obese patients who underwent transhiatal esophagectomy for cancer at the researchers' center between 1977 and 2006.

As noted, the procedure took longer in obese patients, but their hospital length of stay, infection rate, and mortality were comparable to those of the non-obese patients.

Orringer believes that roughly 98 percent of esophageal surgeries can now be performed using the transhiatal approach.

He added that "we always start with the intention of performing a transhiatal esophagectomy." However, the patient is always informed beforehand that a chest incision might be required if the operation can't be completed by going through the abdomen.

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