Metabolic–Bariatric Surgery Reduces Pancreatic Cancer Risk: A Meta‐Analysis of Over 3.7 Million Adults, Independent of Type 2 Diabetes Status

ABSTRACT Aims To investigate the impact of Metabolic–Bariatric surgery (MBS) on pancreatic cancer (PCa) risk in individuals with obesity based on type 2 diabetes(T2D) status. Materials and Methods We conducted a systematic review and meta‐analysis following the Preferred Reporting Items for Systematic Reviews and Meta‐analysis guidelines (PROSPERO: CRD42022367749). The primary outcomes were the PCa incidence rates in participants with or without T2D who underwent MBS compared with the control (non‐MBS) group. Subgroup analyses based on the MBS types were performed and a random‐effects model was employed. Sensitivity analysis was conducted by applying the leave‐one‐out meta‐analysis technique and excluding studies with a short follow‐up. Heterogeneity was evaluated using the I 2 index and Cochran's Q test. Publication bias was assessed with Egger's test and the risk of bias was assessed with the Cochrane Risk‐of‐Bias tool. Results Twelve studies, with 3,711,243 participants, were included. PCa risk was lower in the MBS group for both T2D and the overall population than in the non‐MBS group (RR = 0.46, 95% CI: 0.30–0.71 and RR = 0.21; 95% CI: 0.07–0.57, respectively), with consistent findings after excluding studies with < 3‐year follow‐up. A favourable impact was also observed in individuals without T2D (RR = 0.56, 95% CI: 0.41–0.78). When comparing the types of MBS versus control, a significant difference was observed for sleeve gastrectomy (SG) (RR = 0.24; 95% CI, 0.12–0.46 for SG and RR = 0.52; 95% CI, 0.25–1.09 for Roux‐En‐Y bypass). Egger's test showed no indication of publication bias ( p = 0.417). Conclusions MBS is associated with reduced PCa risk regardless of T2D, with a more pronounced effect in T2D patients. Additional research is needed to investigate the impact of MBS types on PCa.