Confused bariatric surgeons fear cancer

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What Happens When Bariatric Surgeons Forget General Surgery
Numerous Examples Where Bariatric Surgeons Make Decisions Based Upon Errors and Misunderstandings of General Surgery Basics
Most Bariatric Surgeons Do Not Know:

General Surgery Basics

Rate of Gastric Cancer

Lifetime Risk of Gastric Cancer

Published in: Education, Health & Medicine
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Confused bariatric surgeons fear cancer

  1. 1. Bariatric Surgeons vs. General Surgeons; Confusion About General Surgery Basics What Happens When Bariatric Surgeons Forget General Surgery Basics
  2. 2. What Happens When Bariatric Surgeons Forget General Surgery Numerous Examples Where Bariatric Surgeons Make Decisions Based Upon Errors and Misunderstandings of General Surgery Basics
  3. 3. Fear of Cancer • Numerous Critics Bariatric Surgeons have raised Fears of Gastric Cancer after the MiniGastric Bypass • ERRORS in Understanding Basic General Surgery
  4. 4. Misplaced Understanding Magnitude • Most Bariatric Surgeons Do Not Know: • General Surgery Basics • Rate of Gastric Cancer • Lifetime Risk of Gastric Cancer
  5. 5. Lifetime Risk Gastric Cancer • The projected cumulative lifetime incidence of gastric cancer in • H. pylori-infected males is 2.2% and 0.9% for females; • This contrasts with • 0.4 Males & 0.2%, Females, for those never infected. • 2 - 4 / 1,000 patients Lifetime Risk
  6. 6. Lifetime Risk Gastric Cancer • Lifetime Risk gastric cancer 2-4% 2 - 4 / 1,000 • Compared to: • Lifetime risk breast cancer 12% 120 / 1,000 • Prostate cancer risk 16 % 160 / 1,000
  7. 7. Most Bariatric Surgeons Do Not Know: • Risk of Cancer from CAT Scans • Computed Tomography (CT)Abdomen and Pelvis, repeated with and without contrast material • 20 mSv
  8. 8. Most Bariatric Surgeons Do Not Know: • Risk of Cancer from 1 CAT Scan • 2006 report from the National Research Council has estimated that 20 mSv • The approximate dose from 1 CT Abd+Pelvis w/wo contrast = 20 mSv => Inc Cancer Risk 0.2% • 2 / 1000
  9. 9. Now Having Reviewed Most Bariatric Surgeons Do Not Know: Magnitude of Gastric and Other Cancers Risk of Cancer from CT Scan
  10. 10. Most Bariatric Surgeons Do Not Know: • Bariatric Surgeons • Fear of Mice & Bile • Critics of the Billroth II have referred to mouse studies showing increased risk of gastric cancer from "Bile"
  11. 11. Fear of Mice & Bile • Similarly Mouse/Rat Studies have shown • Artificial Sweetener cause cancer • Cell phones cause brain cancer • Mouse virus causes breast cancer • Gingko biloba caused thyroid cancer in mice • Power Lines
  12. 12. Fear of Mice & Bile • Similarly Mouse/Rat Studies have shown • RFID Chips • Genetically Modified corn • Fluoride osteosarcoma • Soy Beans cause Breast Cancer • Bisphenol A Increases Mammary Cancer Risk
  13. 13. Fear of Mice & Bile • Mouse/Rat Studies have that there may be a relation between • Hundreds of things and cancer • RFID Chips, Corn, Fluoride, Soy Beans, plastic, Artificial Sweeteners, Cell phones, Gingko, Power Lines and many more... • and Bile • Bariatric Surgeons Fear Bile(?)
  14. 14. Review of the Basics General GI Surgery and Gastric Cancer What happens when Bariatric Surgeons Forget their General Surgery
  15. 15. GASTRIC CANCER RAPIDLY DECLINING Bariatric Surgeons Do Not Know
  16. 16. *1* GASTRIC CANCER RAPIDLY DECLINING • The incidence of gastric cancer in the United States has • Decreased four-fold since 1930 • Approximately 7 cases per 100,000 people.
  17. 17. *2* WHAT CAUSES GASTRIC CANCER? ITS NOT BILLROTH II • Diets rich in fried, salted, smoked or preserved foods increased cancer risk in many studies. • Foods contain nitrites and these chemicals can be converted to more harmful compounds (carcinogens) by bacteria in the stomach. • Diets high in fruit and vegetables protects against Cancer • Stomach cancer is much more common in smokers and in those with heavy alcohol intake. • H. Pylori, No H. Pylori No Cancer
  18. 18. DIET CAN PREVENT GASTRIC CANCER • Avoid ETOH, Tobacco, Processed & Preserved Meats, Salt • RX H. Pylori, • Eat Fruits and Veggies, Yogurt and • Drink Green Tea • Gonzalez CA, Cancer Research, Institut Català d'Oncologia, Av. Gran Via s/n, km 2.7, 08907 L'Hospitalet, Barcelona, Spain.
  19. 19. CANCER QUIZ: MORE DEADLY CANCER CAUSING AGENT? A OR B A B
  20. 20. CANCER QUIZ: MORE DEADLY Hot Dog or Mini-Gastric Bypass • • • A American Institute for Cancer Research Hot Dog / day Increase the risk cancer 21%
  21. 21. Many Large Studies: No Increased Risk Thousands of patients followed for Decades
  22. 22. Many Large Studies: No Increased Risk • Mayo Clinic Study (Example) • 338 Billroth II patients • Followed 25-years • 5,635 person-years • Only 2 Cancers in 5,000+ pt years of Follow Up • Schafer et al, Risk of gastric carcinoma after treatment for benign ulcer disease. N Engl J Med. 1983 Nov 17;309
  23. 23. BARIATRIC SURGEONS FEAR BILLROTH II MAGNITUDE OF THE PROBLEM • Population based study, 338 Billroth II pts • Followed 25-years • 5,635 person-years • Only 2 Cancers Found in 5,000 years • Predicted 2.6 cancers (relative risk 0.8) Schafer et al, Risk of gastric carcinoma after treatment for benign ulcer disease. N Engl J Med. 1983 Nov 17;309
  24. 24. BARIATRIC SURGEONS FEAR BILLROTH II MAGNITUDE OF THE PROBLEM • 338 Billroth II pts, Followed 25-years • 5,635 person-years • Only 2 Cancers in 5,000 pt years follow up • RATE of Gastric Cancer is Declining • 24 - 50% Expected Decrease from 1983 • Future risk ~1 patient / 5,000 pt years
  25. 25. There are some HUMAN studies that show an increased risk of Gastric Cancer after Billroth II Bariatric Surgeons Forget: These Billroth II operations were done for ULCERS! Ulcers => Increased Risk of Gastric Ca! Both Related to H. Pylori
  26. 26. ULCERS INCREASE RISK CANCER • Meta-analysis: 7 studies Small increased risk 5 studies No Increased Risk • Studies with increased Risk; Flawed • Billroth II = Surgery Rx Ulcers • ULCERS increase risk of Gastric Cancer! • Ulcers and Gastric Cancer Common Etiology =H. Pylori=
  27. 27. ULCERS INCREASE RISK CANCER •3,078 gastric cancer vs. 89,082 controls •Ulcer increases risk gastric cancer =(relative risk 1.53)= •Same as Increased Risk reported Billroth II •Many other studies confirm these findings: •Ulcer Increases Risk Gastric Cancer •Ulcers & Gastric Cancer: •Common Etiology = H. Pylori
  28. 28. General, Trauma and Oncologic surgeons routinely use the Billroth II (Thousands of publications) UNINFORMED FEAR BILLROTH II EDUCATED USE BILLROTH II
  29. 29. UNINFORMED FEAR BILLROTH II EDUCATED USE BILLROTH II • Billroth II and the Mini-Gastric Bypass Excellent, Safe and Effective • Fear Cancer? CAT Scan much more likely to cause cancer! • FEAR Gastric Cancer? Avoid ETOH, Tobacco, Processed & Preserved Meats, Rx H. Pylori, Eat Fruits and Veggies, Yogurt • A Billroth II probably makes NO difference
  30. 30. Rational Data Analysis vs. Irrational FEAR Gastric Cancer • 1. Gastric Cancer Declining Rapidly • 2. GC Environmental Causes; Easily Prevented • 3. Some studies show Small Increased Risk Probably from Ulcers / H. Pylori • 4. Many large studies: NO increased risk • 5. Endoscopic Screening: Not Recommended • 6. General, Trauma & Oncologic Surgeons Use Billroth II
  31. 31. Bariatric Surgeons Fear of Cancer after MGB Misplaced! Fear Cancer After Bariatric Surgery Fear Esophageal Cancer After Sleeve, Band and Plication

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