Early gastric cancer found at preoperative assessment for bariatric surgery

An association between gastric cancer and obesity has been suggested in large epidemiologic series. We present a 61-year-old lady with BMI 48.7 kg/m2, who underwent preoperative work-up for Roux-en-Y gastric bypass. Her endoscopy showed a depressed lesion at the incisura angularis, suggesting early gastric cancer. The biopsy confirmed well/moderately-differentiated adenocarcinoma. The surgical approach was subtotal gastrectomy leaving only part of the fundus, and was performed on an oncological basis, with lymphatic D2 dissection. The gastro-enterostomy was 1.5 cm wide, and was constructed closer to the greater curvature over a 12-Fr Fouchet tube. The reconstruction was in a Roux-en-Y fashion, but the alimentary limb was 150 cm long. Despite the short follow-up, the way the surgery was conducted presumably maintained both oncologic and bariatric determinations.