Bariatric surgery tied to ‘significant reduction’ in risk for esophageal, gastric cancer
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Bariatric surgery was associated with a decreased incidence of esophageal and gastric cancer as well as in-hospital mortality in a cohort of patients with severe obesity, according to results published in JAMA Surgery.
“Little information is available on the incidence of esophagogastric cancer after bariatric surgery in large cohorts,” Andrea Lazzati, MD, PhD, of the department of general surgery at the Intercommunal Hospital Center of Creteil in France, and colleagues wrote. “Therefore, using a national administrative database, we performed a study on a nationwide scale comparing the incidence of esophageal and gastric cancer between patients with obesity who underwent bariatric surgery and those who did not (control group).”
Lazzati and colleagues enrolled 303,709 adult patients (80.9% women; mean age, 40.2 years) with severe obesity who underwent bariatric surgery between 2010 and 2017 and were cancer-free for 2 years, as well as 605,140 matched patients (82.8% women; mean age, 40.4 years) who did not undergo surgery.
After a mean follow-up of 5.62 years in the control group and 6.06 years in the bariatric surgery group, researchers reported 254 and 83 incidences of esophagogastric cancer, respectively. Gastric cancer was nearly twofold more common than esophageal cancer in both groups.
The incidence rates were 6.9 per 100,000 population per year and 4.9 per 100,000 population per year for control and surgical groups, respectively, which translated to an overall incidence rate ratio of 1.42 (95% CI, 1.11-1.82).
Multivariable analyses yielded no significant difference in cumulative cancer incidence among patients in the control group vs. patents who underwent adjustable gastric banding (HR = 0.84; 95% CI, 0.47-1.51) or sleeve gastrectomy (HR = 0.86; 95% CI, 0.63-1.18), though there was a “significant decrease” in cancer incidence following gastric bypass (HR = 0.62; 95% CI, 0.4-0.95).
Overall, patients in the surgery group had a lower incidence of esophagogastric cancer (HR = 0.76; 95% CI, 0.59-0.98), as well as lower in-hospital mortality (HR = 0.6; 95% CI, 0.56-0.64).
“In this large, nationwide cohort of patients with severe obesity, bariatric surgery was associated with a significant reduction of esophageal and gastric cancer incidence and overall in-hospital mortality,” Lazzati and colleagues concluded. “The findings suggest that bariatric surgery can be performed as treatment for severe obesity without increasing the risk of esophageal and gastric cancer.”
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