Should laparoscopic sleeve gastrectomy specimens be examined histopathologically? Experience of two hundred forty-six patients in university hospital

Year 2019, Volume: 33 Issue: 1, 57 - 67, 26.04.2019

Serhan Derici , Koray Atila Özgül Sağol

https://doi.org/10.5505/deutfd.2019.60590

Abstract

INTRODUCTION: Laparoscopic sleeve gastrectomy has become an increasingly common practice in recent years.In this method,about 1000-1100ml stomach is resected.In the case reports or case series,incidental malignant lesions have been reported.The aim of this study was to evaluate the histopathologic results of patients,undergoing laparoscopic sleeve gastrectomy and to discuss the factors affecting the development of malignant lesions.
METHODS: In accordance with the criteria of the World Health Organization,LSG surgeries were performed in246 consecutive patients between January2013and October2017 in a single academic center.Prospectively recorded medical data of these patients were retrospectively reviewed.
RESULTS: 72.4% of the patients were female.The average BMIwas 45,4kg/m2. The most common pathological finding was gastritis.Three patients had incidental malignancy,two patients had atrophic gastritis and extensive intestinal metaplasia.These malign lesions could not be detected in the preoperative evaluations of patients.
DISCUSSION AND CONCLUSION: In recent years there has been a significant increase in the number of bariatric operations performed for elderly patients.In spite of"the older age"was not found as a risk factor for malignancy in our study,the incidence of malignancy in older people is higher than that of younger individuals.Due to increasing of the elderly patient, the malignant lesions may increase.If these lesions have a small size or they locate at subserosa, they may not be detected in preoperative examinations.
Even if no pathologic findings are found in the preoperative endoscopic evaluation,the anterior and posterior wall of the stomach should be fully mobilized to look for possible subserosal lesions in LSG procedure.Histopathologic examination of all gastric specimens should be performed for potential incidental occult malignancies.

Keywords

Obesity, Sleeve gastrectomy, GIST, NET

Laparoskopik sleeve gastrektomi spesmenleri histopatolojik olarak incelenmeli mi? Bir üniversite hastanesinin 246 hastadaki deneyimi

Abstract

GİRİŞ ve AMAÇ: Morbid obezitenin cerrahi tedavisi için laparaskopik sleeve gastrektomi (LSG) son yıllarda giderek daha sık uygulanan bir yöntem haline gelmiştir. Bu yöntemde yaklaşık 1000-1100ml hacminde bir mide kısmı rezeke edilmektedir. Midenin rezeke edilen bu kısmının değerlendirildiği çalışmaların bir kısmında rastlantısal malign lezyonların görüldüğü bildirilmiştir. Çalışmamızda laparoskopik sleeve gastrektomi ameliyatı yapılan hastaların histopatolojik sonuçlarının değerlendirilmesi, varsa malign lezyonların gelişiminde etki eden faktörlerin tartışılması amaçlanmıştır.
YÖNTEM ve GEREÇLER: Dünya sağlık örgütü ölçütlerine uygun olarak tek akademik merkezde Ocak 2013 – Ekim 2017 tarihleri arasında LSG ameliyatı yapılmış ardışık 246 hastanın prospektif olarak kayıt altına alınan tıbbi verileri retrospektif olarak incelendi.
BULGULAR: Hastaların %72,4’ü kadındı. Ortalama VKİ: 45,41kg/m2 olarak belirlendi. En sık görülen patolojik bulgu gastrit idi. Üç hastada rastlantısal malignite iki hastada atrofik gastrit ve yaygın intestinal metaplazi saptandı. Malignite saptanan hastaların ameliyat öncesi değerlendirmelerinde bu bulgulara rastlanmamıştı.
TARTIŞMA ve SONUÇ: Son yıllarda özellikle ileri yaştaki hastalara uygulanan bariyatrik ameliyat sayılarında ciddi artış vardır. Obezite diğer sistemik hastalıklar için olduğu gibi malignite gelişimi için de risk faktörüdür. Her ne kadar bizim serimizde yaş malignite için anlamlı değişken olarak saptanamamış olsa da yaşlı obez hastaların daha fazla ameliyat ediliyor olması, mide histopatolojilerinde daha fazla malign bulguya rastlanmasına neden olacaktır. Bu malign lezyonların küçük ve subserozal yerleşimli olması halinde, ameliyat öncesi incelemelerde gözden kaçma olasılıkları bulunmaktadır. 
Ameliyat öncesi endoskopik muayene yapılmalı, burada patolojik bulguya rastlanmasa bile LSG prosedüründe midenin ön ve arka yüzü serozal-subserozal lezyonların araştırılması için mutlaka mobilize edilmelidir. Rezeksiyon sonrası tüm mide spesmenlerinin histopatolojik incelemesi, rastlantısal malignitelerin gözden kaçmaması adına uygun olacaktır.

Keywords

Obezite, Tüp mide, GİST, LSG, Nöroendokrin tümör

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