Jennifer E Baker, BA, Amy Rosenbluth, MD, James Buwen, DO, Michael R Kammerer, MD, Alec C Beekley, MD, David S Tichansky, MD. Thomas Jefferson University Hospital
Obesity is a risk factor for a multitude of cancers. The underlying cause of this association is, at least partly, related to the chronic inflammatory state of obesity. GastroIntestinal Stromal Tumors(GISTs) have a reported incidence of 10-20 per million in the general population. While GISTs have not been directly associated with obesity, observed incidence is seemingly greater than the previously reported data. The purpose of this study was to determine the true incidence of GIST in morbidly obese patients.
A retrospective review was performed on prospectively collected data of consecutive laparoscopic bariatric procedures from 8/12 to 6/13. Thorough intra-operative examination of the stomach to identify possible pathology was performed during each case, and the procedure was modified if necessary. All sleeve resection specimens were routinely sent to Pathology for microscopic examination.
209 consecutive patients undergoing primary laparoscopic bariatric procedures at our institution were included in the study. All patients denied symptoms common of GIST (abdominal pain, nausea, vomiting, palpable mass, or blood in the stool/vomit) in the preoperative period and no patients had GISTs definitively identified on pre-operative endoscopy. Five pathology-proven GISTs were found in 4 patients (1.9%). Half of these patients required modification of their procedure to achieve oncologically appropriate resection margin.
Bariatric surgery patients have a dramatically greater incidence of GIST than previously reported in the general population (1.9% vs. 0.001%). During bariatric surgery, meticulous examination of the stomach should be performed to facilitate resection of asymptomatic GISTs before they become clinically relevant.