Bariatric surgery treats severe obesity without increasing esophageal and gastric cancer risk: JAMA

Previous studies have mentioned that Bariatric surgery reduces the risk of cancer in obese patients. This perspective is controversial and requires more data. However, there needs to be more clarification on the association of bariatric surgery with esophageal and gastric cancer.

The question here is, does esophagogastric cancer risk increase with bariatric surgery?

To find out more, a team of researchers from Centre Hospitalier Intercommunal de Créteil, France, did a cohort study of 908849 patients with severe obesity. The lead researcher and co-researcher were Andrea Lazzati and Tigran Poghosyan  MD, PhD.

The study's primary outcome was the incidence of esophageal and gastric cancer, while overall in-hospital mortality was the secondary outcome.

The study points are:

• The data were obtained from the national discharge database, including surgical centres, in France (January 1, 2010, to December 31, 2017).
• The study included adults ≥18 years with severe obesity.
• There were two groups: Surgical and control.
• The study was conducted from March 1, 2020, to June 30, 2021.
• 303 709 patients underwent bariatric surgery, with 80.9 % females of mean age 40.2 years. This was matched 1:2 with 605 140 patients who did not receive surgery, including 82.8 % females of mean age 40.4 years.
• The mean follow-up duration was 5.62 years and 6.06 years in the control and surgical groups, respectively.
• Three hundred thirty-seven patients had esophagogastric cancer, including 83 in the surgical group and 254 in the control group.
• The incidence rates were 6.9 per 100 000 population per year and 4.9 per 100 000 per year for the control and surgical groups, respectively.
• The incidence rate ratio of 1.42.
• The hazard ratio (HR) of cancer incidence was significantly in favour of the surgical group, with an HR of 0.76.
• The mortality was significantly lower in the surgical group having an HR of 0.60.

To conclude, the finding of study suggest that bariatric surgery can be performed as a treatment for severe obesity without increasing the risk of esophageal and gastric cancer. It also reduces overall in-hospital mortality.

Further reading:

Lazzati A, Poghosyan T, Touati M, Collet D, Gronnier C. Risk of Esophageal and Gastric Cancer After Bariatric Surgery. JAMA Surg. Published online January 11, 2023. doi:10.1001/jamasurg.2022.6998