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Esophageal Cancer Rates Climb With Obesity

l cancer and Barrett’s esophagus with severe precancerous changes. It was originally developed at the University of Michigan as a surgical alternative to removing the esophagus by going through the chest, a much more difficult operation for the patient.

The researchers sought to determine if THE is a safe procedure for the growing number of obese patients requiring esophageal surgery. They pulled the records of 133 profoundly obese patients who had this surgery at U-M between 1977 and 2006. Profound obesity was defined as a body mass index of 35 or more. Those 133 patients were matched to a randomly selected control group of non-obese patients undergoing the same procedure. Both groups were matched for factors including gender, age, year of operation and pre-existing medical conditions.

After comparing measures such as hospital length of stay, infection and mortality, the researchers found both groups had comparable outcomes. This suggests the THE procedure is safe to perform in obese patients. The study authors stress, however, that the results may be influenced by the high volume of patients U-M surgeons see for this procedure. U-M surgeons perform 120 to 150 transhiatal esophagectomies each year and have completed more than 2,000 of these procedures in total. Because the procedure in obese patients is more demanding on surgeons, the results may not be the same in hospitals that see relatively few patients in need of an esophagectomy.

“Profoundly obese patients undergoing a THE at a high-volume center can have surprisingly and acceptably low morbidity and mortality rates, similar to those of non-obese individuals matched for co-morbidities,” says Orringer, head of the U-M Section of Thoracic Surgery and co-director of the Thoracic Oncology Program at the U-M Comprehensive Cancer Center.

Currently about 85 percent of esophageal cancers removed in this country are adenocarcinomas, most related to obesity and reflux di
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