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A Review of the Role of Robotics in Bariatric Surgery

Originally published Journal of Surgical Oncology 2015;112:279–283

KEY WORDS: bariatric surgery; robotics; obesity; gastric bypass; gastrectomy; biliopancreatic diversion; laparoscopy; cancer

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INTRODUCTION

The number of obese children, adolescents, and adults continues to
rise exponentially and represents a major health issue. Even more
alarming is the increase in patients who are considered morbidly obese
(body mass index [BMI] over 40) [1]. Today, roughly two out of every
three adults in the US are overweight and one out of every three adults
are considered obese. Globally, it is estimated that 500 million adults
are obese and 43 million preschool children are overweight or obese [2].
The adverse consequences of obesity have been recognized for decades.
There are multiple studies showing the correlation between obesity and
cardiovascular disease, diabetes, metabolic syndrome, arthritis, and
even increased risk of cancer [2–4]. In June 2013, the American
Medical Association formally adopted a policy designating obesity as a
chronic disease [5].

OBESITY AND CANCER

The association of obesity and increased risk of cancer has been
shown in several studies. This association has best been demonstrated in
what has traditionally been thought of as high BMI-related cancers,
such as esophageal (adenocarcinoma), colon, rectal, kidney, pancreas,
gallbladder, and postmenopausal breast and ovarian cancer [4]. Lim
et al. [6] estimated that 3.9% of cancer mortality in 2010 could be
attributed to high BMI. Arnold et al. evaluated worldwide cancer
incidence and its association to BMI. Interestingly, they found that
481,000 (3.6%) of all new cancers cases and 12.8% of all high BMIrelated
cancers in adults were attributable to obesity. The majority of
cases attributed to obesity in this study included uterine, colon, and
breast cancer. The relation of obesity to new cancer cases was
significantly higher in developed as compared to developing countries.
Interestingly, but not surprisingly, this mirrors global obesity
statistics [3,4].

BARIATRIC SURGERY AND CANCER RISK

Recently, there have been several studies looking at the effect of
bariatric surgery on cancer incidence and oncologic outcomes [7,8].
The data are mostly observational studies; however, conclusions
favoring bariatric surgery can be drawn. Two meta-analyses of the
published data concluded that patients undergoing bariatric surgery
when compared to obese individuals who had not undergone surgery

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