Sleeve Gastrectomy and Gastric Cancer: Is It Really Rare?
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LETTER TO THE EDITOR
Sleeve Gastrectomy and Gastric Cancer: Is It Really Rare? Luigi Angrisani 1 & Rossella Palma 2
&
Antonella Santonicola 3 & Luca Ferraro 4 & Paola Iovino 3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Sleeve gastrectomy (SG) is currently the most frequently performed bariatric procedure worldwide [1]. Although incidental stromal tumor diagnosis of the SG specimen has been occasionally found [2, 3], gastric adenocarcinoma has been rarely reported. A 45-year-old woman with a body mass index (BMI) of 37.95 kg/m2, with sleep apnea and osteoarthropathy, and without cancer familiarity underwent laparoscopic SG in January 2020. A routinary preoperative upper gastrointestinal endoscopy (UGIE) was performed showing an antral mucosal hyperemia without evidence of any pathological findings, erosions, or ulcerative lesions. Biopsies were performed for histological examination according to the Sydney System and resulted negative for Helicobacter pylori infection. At the time of surgery, by using the Covidien Signia™ Stapling System, the first antral stapler fire was performed with a black reinforced reload (60 mm lengths). Signia™ Stapling System technology can adapt firing speed according to tissue thickness variability. By observing a very slow firing progression, an unusual tissue resistance was suspected. However, SG was completed without intraoperative complications. During specimen retrieval through the 15-mm trocar incision without the plastic bag, abnormal antral thickness and rigidity were appreciated. Therefore, the gastric specimen was opened through the staple line and antral mucosa appeared completely normal as well as the serosal surface. By
* Rossella Palma [email protected] 1
Department of Public Health, “Federico II” University of Naples, Naples, Italy
2
Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
3
Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
4
Department of Advanced Biomedical Sciences, “Federico II” University of Naples, Naples, Italy
manual palpation of the gastric wall, an intramural 20–30-mm solid lesion of the greater curvature, in the antral region, was detected. The patient had an uncomplicated postoperative course and was discharged on the second postoperative day. The postoperative histological diagnosis of the gastric specimen demonstrated a poorly differentiated signet-ring cell carcinoma according to the World Health Organization (WHO) classification at the antrum. The resection margins were positive for tumor presence. A full-thickness infiltration of the gastric wall was detected (pT4a). Total-body computed tomography (CT) was performed with the evidence of a gastric wall thickening, perigastric adipose tissue densification with some small lymph nodes (maximum diameter = 5 mm), and a 10-mm peritoneal nodule very close to the rectum abdominis muscle. The positron emission tomography (PET) did not confirm this pathological finding and no d
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