The rapidly climbing obesity rates in the United States have created a higher risk of esophageal cancer linked to reflux disease. And this has some surgeons wondering// if a currently popular procedure to remove the esophagus is as safe in obese patients.

According to a new study at the University of Michigan Health System, obese patients who underwent a procedure called transhiatal esophagectomy primarily for esophageal cancer had outcomes similar to their lean counterparts.

“The type of patient who currently develops esophageal cancer has changed dramatically in the last 20 years. Esophageal cancer used to be primarily squamous cell carcinoma found in people who drank alcohol and smoked excessively. In association with the horrendous epidemic of obesity in this country, we have seen a 350 percent increase of adenocarcinoma over the last 30 years.

This is related to more gastroesophageal relux and Barrett’s esophagus in these patients,” says Mark Orringer, M.D., John Alexander Distinguished Professor of Surgery at the U-M Medical School.

Orringer and lead study author Christopher Scipione, a U-M medical student, will present the study results Tuesday, Jan. 30, at the Society of Thoracic Surgeons 43rd annual meeting in San Diego.

Adenocarcinoma of the esophagus is often the result of chronic reflux disease. When acid continuously backs up into the esophagus, it wears down the natural lining. This can cause a condition called Barrett’s esophagus in which the body replaces the normal esophageal lining with one similar to that found in the intestines. People who develop Barrett’s are at a higher risk of developing adenocarcinoma.

Transhiatal esophagectomy, or THE, is an operation in which most of the esophagus is removed without the need to open the chest, and swallowing is restored by pulling the stomach to the neck and connecting it there to the remaining esophagus. THE is used to treat esophagea
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