Metabolic surgery slashed risk for adverse outcomes in MASH-related cirrhosis, obesity
Key takeaways:
- Metabolic surgery was associated with a 72% lower risk for incident major adverse liver outcomes vs. nonsurgical management.
- It was also associated with an 80% lower risk for progression to decompensation.
Metabolic surgery significantly lowered risk for major adverse liver outcomes vs. nonsurgical management among patients with obesity and compensated cirrhosis from metabolic dysfunction-associated steatohepatitis, according to study data.
“Current guidelines recommend lifestyle modification or weight reduction for the treatment of cirrhosis, but people need to lose a large amount of weight and keep it off for a long period of time to see a real impact on their liver and liver-related outcomes,” Ali Aminian, MD, FACS, FASMBS, director of the Bariatric and Metabolic Institute at the Cleveland Clinic and professor of surgery at Cleveland Clinic Lerner College of Medicine, told Healio. “Our study provides hope that losing a large amount of weight with metabolic surgery can change the trajectory of the disease.”
To compare major adverse liver outcomes with surgical vs. nonsurgical management, Aminian and colleagues conducted the Surgical Procedures Eliminate Compensated Cirrhosis in Advancing Long-term (SPECCIAL) study, a retrospective observational cohort study of 168 patients aged 18 to 80 years (mean age, 54.4 years; 69.6% women; 91% white) with compensated biopsy-proven MASH-related cirrhosis and obesity.
The researchers categorized patients into two groups: those who underwent metabolic surgery (n = 62) and those who received nonsurgical management (n = 106).
In the surgical group, 59.7% of patients underwent Roux-en-Y gastric bypass (n = 37) and 40.3% underwent sleeve gastrectomy (n = 25).
The primary composite endpoint of the study was incident major adverse liver outcomes, which the researchers defined as the first occurrence of ascites, variceal hemorrhage, hepatic encephalopathy, hepatocellular carcinoma, liver transplantation or all-cause mortality. The secondary composite endpoint was progression from compensated to decompensated cirrhosis.
Mean follow-up was 10 ± 4.5 years, including 10.1 ± 3.7 years in the surgical group and 9.9 ± 5.1 years in the nonsurgical group.
At 15 years, the cumulative incidence of major adverse liver outcomes was 20.9% (95% CI, 2.5-35.9) in the surgical group vs. 46.4% (95% CI, 25.6-61.3) in the nonsurgical group (adjusted HR = 0.28; 95% CI, 0.12-0.64), according to the researchers.
They also observed that the cumulative incidence of decompensated cirrhosis at 15 years was 15.6% (95% CI, 0-31.3) in the surgical group vs. 30.7% (95% CI, 12.9-44.8) in the nonsurgical group (aHR = 0.2; 95% CI, 0.06-0.68).
“In the future, we’d like to see if we can replicate these findings with no surgery,” Aminian said. “It’s going to be extremely important to show that new weight loss medications such as Ozempic (semaglutide, Novo Nordisk) and Mounjaro (tirzepatide, Lilly) can provide similar improvements in this patient population.”
Although not all patients will be candidates for surgery, they should still be evaluated by multidisciplinary teams at bariatric surgery centers, he added.
“If they feel that the patient is eligible and the risk is acceptable, the patient will undergo surgery,” Aminian told Healio. “If they feel that it’s too risky and the patient is not a good candidate, then they won’t do the surgery. Regardless, the initial conversation should be started by the hepatologists and primary care physicians who take care of these patients.”
The researchers acknowledged several study limitations, including the risk for selection bias and the fact that 90% of patients were white, limiting the generalizability of the results to individuals in other racial and ethnic groups.
For more information:
Ali Aminian, MD, FACS, FASMBS, can be reached at aminiaa@ccf.org.
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