Bariatric surgery in patients with kidney cancer. Stages of surgical treatment

Background. Morbid obesity (MO) does not only increase the risk of developing malignant neoplasms (MN) of various localisations, including renal cell carcinoma (RCC), but also worsens the treatment outcomes and prognosis in patients with diagnosed cancer. Bariatric surgery, as the only proven effective option for significant and persistent reduction in body mass, has recently been used in cancer patients at various stages. However, the issues regarding the prognostically most promising and beneficial treatment staging from the patient’s perspectives, and the possibility of simultaneous interventions for MN and MO remain unsolved.

Aim. Тo analyse a series of cases of surgical treatment in patients with RCC and subsequent bariatric procedures for MO, and to report on the first known experience of simultaneous implementation of bariatric and oncological stages.

Materials and methods. There were presented three clinical cases of bariatric interventions in patients with RCC: 1) kidney cancer diagnosed during preparation for bariatric surgery. The first stage was nephrectomy, the second was sleeve gastrectomy (SG); 2) SG for progressive obesity in 5 years after nephrectomy for RCC; 3) simultaneous surgical treatment involving partial nephrectomy and SG for RCC and MO. Surgical complications, oncologic and bariatric outcomes were assessed.

Results. No treatment complications were observed during oncological and bariatric surgeries in any case. All patients demonstrated significant and persistent weight loss after bariatric surgery. The excess weight loss were 110.9% (after 62 months), 85.7% (after 23 months) and 71.0% (after 24 months) in cases 1, 2 and 3, respectively. In each case, follow-up imaging (SCT) revealed no tumor recurrence.

Conclusions. Elimination of MO should be considered a crucial aspect in the treatment of patients with MN, including RCC. A personalised treatment strategy should be planned based on the individual patient’s features, prognosis and safety assessment. Simultaneous bariatric and oncological surgeries can be supportable both in terms of simultaneously addressing two interrelated conditions and in reducing the risk of malignant neoplasm progression or recurrence. The initial clinical outcomes indicate that this approach may be effective; however, such simultaneous interventions can only be performed in specialised medical institutions with the necessary level of the staff training, adequate equipment and experience.