Plenary Session

Impact of Bariatric Surgery on Cancer and Mortality

Raul J. Rosenthal, MD, FACS, FASMBS
Regional Chair, Digestive Disease Institute, Cleveland Clinic Florida
Chairman,  Department of General Surgery
Director, General Surgery Residency Program 
Director, The Bariatric and Metabolic Institute, 
Director, Advanced GI Surgical Fellowship
Cleveland Clinic Weston
Weston, FL
Clinical Professor of Surgery at
Cleveland Clinic Lerner College of Medicine at
Case Western Reserve University
Affiliate Professor of Surgery at 
Herbert Wertheim School of Medicine, Florida International University
Charles E. Schmidt College of Medicine, Florida Atlantic University
Ross University, School of Medicine
Co-Editor in Chief, Surgery for Obesity and Related Diseases (SOARD)

Dr. Rosenthal completed his medical school and surgical residency in Rosario Argentina. In 1982 he emigrated to Frankfurt , Germany where  he repeated general surgery residency and became attending surgeon at the Northwest Hospital. In 1993 Dr. Rosenthal emigrated to the USA.  Three years of minimally invasive surgery fellowship at Cedars Sinai Medical Center in LA were followed by third general surgery residency  at Mount Sinai Medical Center  in NY. Since 1999 he is  Chief of MIS and Bariatric Surgery and director of Fellowship in Minimally Invasive and Bariatric Surgery at Cleveland Clinic Florida. In 2019 Dr. R was appointed Regional Director of the Digestive Disease Institute of Cleveland Clinic Florida.  Since 2012 he is  the Chairman of the Department of General Surgery and since 2011 the director of the General surgery Residency Program. Dr. Rosenthal served between 2014 and 2016 as Chief of Staff and Chairman of the Medical Executive Committee at Cleveland Clinic Florida. Dr. Rosenthal was appointed for 6 years in the Board of Governors of SAGES and served for equal amount of time in the SAGES Foundation .Dr. Rosenthal is Founding member and immediate past president of the Fellowship Council.  He also served on multiple committee’s and  is  President of the American Chapter of the International Federation of Societies of Obesity Surgery and Past president of the American Society of Metabolic and Bariatric Surgeons ( ASMBS)  and past president of the ASMBS Foundation, South Florida Chapter of ACS  and the Fellowship Council. He is a founding member and secretary treasurer of the International Society of Fluorescent Image Guided Surgery. He is Editor in Chief of SOARD, Editor of SURGERY and  founding  Clinical Editor of Bariatric Times. He also serves as associate editor of Obesity Surgery. Additionally he is Editorial Board member of Annals of Surgery, Selected Readings in General Surgery,  and Surgical Endoscopy. He is the immediate past  President of the South Florida Chapter of the American College of Surgeons and Governor at the American College of Surgeons. Dr. R is honorary member of several surgical societies including the Federation of Latin-American Surgeons, Argentinian, Indian, Peruvian, Bolivian, German and Israeli Societies of surgery. Dr. R. conducted well over 10,000 general surgery and bariatric procedures and trained over 60 fellows in advanced gastrointestinal, minimally invasive and bariatric surgery. He is author or co-author in over 500 abstracts and peer reviewed publications, more than 60 book chapters and over 200 educational videos. He has contributed over 90 book chapters  is the Co Editor of several books including the  ASMBS Bariatric Surgery Book, Globesity , Netter’s Gastroenterology, The Pathophysiology of Pneumoperitoneum, Fluorescent Imaging for Surgeons, Operative Strategies in Laparoscopic Surgery, Weight Loss Surgery and Mental Conditioning for Common Operations in Surgical  Training.

Presentation Overview:

Currently, the prevalence of obesity in the United States (US) and worldwide continues to grow significantly and the awareness about its associated complications seems to be exponentially increasing as well. In the past three decades, 1769 studies from 104 different centers have highlighted the health risks and significant increase in the prevalence of obesity around the world.  This increasing trend has become a worldwide concern due to several potential associated comorbidities. Nearly all Americans (94%) agree that obesity itself, even when no other diseases are present, increases the risk for early death, tying cancer as the most concerning health issue being faced by the country in modern time. The concerning rise of worldwide obesity has led to an exponential increase of bariatric surgery making weight loss surgeries the standard of care treatment for obesity and its metabolic implications.

Both obesity and the stimulating effect of fat on carcinogenesis have been well established. The International Agency for Research into Cancer (IARC) has concluded that excess body weight is associated with an elevated risk of developing various types of cancers. Despite the multifactorial etiology of carcinogenesis, there is sufficient evidence for an association with excess body fat, including overweight, obesity and weight gain, with at least 13 cancers. Thus far, the included cancers are adenocarcinoma of the esophagus, postmenopausal breast malignancies, renal cell carcinoma, endometrial, gallbladder, gastric, ovary, thyroid, colorectal cancer, meningioma, and multiple myeloma. This means obesity is associated to at least 55% of cancers diagnosed in women and 24% in men. Similarly, obesity is associated with 15 to 20% of all cancer deaths. However, a major challenge hampers this obesity-cancer association. Both biologically and epidemiologically, the basis for this relationship remains unresolved. Three candidate systems, namely insulin and insulin-like growth factors, sex hormones, and adipokines, have been studied as popular hypotheses linked to cancer development. More recently, the popular inference on carcinogenesis and fat excess is the obesity-related hypoxia, shared genetic susceptibility, and migrating adipose stromal cells. 

The rationale of the carcinogenic effect of excess adiposity is based on the induction of metabolic and endocrine abnormalities, including increases in inflammatory markers, insulin, sex hormones, and insulin-like growth factor. The aim of this presentation is to further clarify and strengthen the impact of bariatric surgery and rapid weight loss in decreasing the likelihood to develop cancer.