Our Summary

This research paper discusses the increasing rates of metabolic surgery (used to treat conditions like obesity and diabetes) and esophageal cancer over the past 20 years. The authors present two case studies of patients who had previously undergone a type of metabolic surgery called sleeve gastrectomy and later needed an esophagectomy (removal of part or all of the esophagus) due to esophageal cancer.

Since these patients did not have the usual option of using a part of the stomach for the reconstruction after the esophagectomy, the surgeons planned to use a part of the colon instead. This is known as a colon interposition graft. The paper discusses the details of these two specific cases, the technique of colon interposition, and things to consider when planning such a surgery.

The authors suggest that as the rates of metabolic surgery and esophageal cancer continue to rise, the need for these types of complex reconstruction surgeries may also increase in the future.

FAQs

  1. What is the relationship between metabolic surgery and the rise in esophageal cancer?
  2. What is the colon interposition technique and when is it used in esophagectomy?
  3. How does a previous sleeve gastrectomy affect the process of esophagectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about esophagectomy is to follow all pre-operative instructions carefully, such as fasting before surgery and avoiding certain medications. It is also important to discuss any concerns or questions with your healthcare team before the procedure. After surgery, it is important to follow all post-operative care instructions, including taking medications as prescribed, attending follow-up appointments, and gradually reintroducing food and liquids as directed. It is important to communicate any new symptoms or concerns to your healthcare team promptly.

Suitable For

Patients who are typically recommended esophagectomy include those with esophageal cancer, Barrett’s esophagus, achalasia, and other esophageal disorders that cannot be managed with other treatments. In the cases presented in the abstract, patients who had undergone sleeve gastrectomy and required esophagectomy due to their condition were recommended for the procedure. These patients did not have the option of using a gastric conduit for reconstruction, so a colon interposition graft was planned for their reconstructions. The need for this reconstruction technique may increase in the future as both metabolic surgery and esophageal cancer continue to rise in prevalence.

Timeline

Before esophagectomy:

  • Patient undergoes sleeve gastrectomy for metabolic syndrome
  • Patient is diagnosed with esophageal cancer
  • Patient is evaluated and deemed a candidate for esophagectomy
  • Colon interposition graft is planned for reconstruction

After esophagectomy:

  • Patient undergoes esophagectomy surgery
  • Patient undergoes colon interposition graft for reconstruction
  • Patient undergoes postoperative recovery and rehabilitation
  • Patient undergoes follow-up appointments for monitoring and management of any complications or side effects
  • Patient may require additional treatments such as chemotherapy or radiation therapy for esophageal cancer

Overall, the patient experiences a significant medical journey from metabolic surgery to esophagectomy, with a focus on recovery and long-term management of esophageal cancer.

What to Ask Your Doctor

  1. What is the reason for needing an esophagectomy after sleeve gastrectomy?
  2. What are the potential risks and complications associated with esophagectomy?
  3. What is the expected recovery time and post-operative care after esophagectomy?
  4. Will I need any additional tests or procedures before the esophagectomy?
  5. What are the long-term effects of having an esophagectomy, particularly after sleeve gastrectomy?
  6. Are there alternative reconstruction techniques to colon interposition that could be considered?
  7. What is the success rate of colon interposition graft for esophageal reconstruction?
  8. Will I need any dietary or lifestyle changes after the surgery?
  9. How often will I need follow-up appointments after the esophagectomy?
  10. Are there any support groups or resources available for patients undergoing esophagectomy after sleeve gastrectomy?

Reference

Authors: Jureller M, Logarajah SI, Van Meter TA, Osman H, Jay J, Moslim M, Aye R, Jeyarajah DR. Journal: J Gastrointest Surg. 2023 Apr;27(4):653-657. doi: 10.1007/s11605-022-05378-x. Epub 2022 Aug 12. PMID: 35962213