Decreased Risk of Esophageal Adenocarcinoma after Gastric Bypass Surgery in a Cohort Study from Three Nordic Countries

医学 腺癌 危险系数 入射(几何) 食管切除术 胃旁路手术 食管腺癌 队列 内科学 外科 肥胖 人口 共病 队列研究 胃肠病学 减肥 巴雷特食管 胃分流术 癌症 食管癌 置信区间 物理 光学 环境卫生
作者
Johan Hardvik Åkerström,Giola Santoni,My von Euler Chelpin,Swathikan Chidambaram,Sheraz R. Markar,John Maret‐Ouda,Eivind Ness‐Jensen,Joonas H. Kauppila,Dag Holmberg,Jesper Lagergren
出处
期刊:Annals of Surgery [Lippincott Williams & Wilkins]
被引量:4
标识
DOI:10.1097/sla.0000000000006003
摘要

The objective of this study was to test the hypothesis that bariatric surgery decreases the risk of esophageal and cardia adenocarcinoma.Obesity is strongly associated with esophageal adenocarcinoma and moderately with cardia adenocarcinoma, but whether weight loss prevents these tumors is unknown.This population-based cohort study included patients with an obesity diagnosis in Sweden, Finland, or Denmark. Participants were divided into a bariatric surgery group and a nonoperated group. The incidence of esophageal and cardia adenocarcinoma (ECA) was first compared with the corresponding background population by calculating standardized incidence ratios (SIR) with 95% CIs. Second, the bariatric surgery group and the nonoperated group were compared using multivariable Cox regression, providing hazard ratios (HR) with 95% CI, adjusted for sex, age, comorbidity, calendar year, and country.Among 748,932 participants with an obesity diagnosis, 91,731 underwent bariatric surgery, predominantly gastric bypass (n=70,176; 76.5%). The SIRs of ECA decreased over time after gastric bypass, from SIR=2.2 (95% CI, 0.9-4.3) after 2 to 5 years to SIR=0.6 (95% CI, <0.1-3.6) after 10 to 40 years. Gastric bypass patients were also at a decreased risk of ECA compared with nonoperated patients with obesity [adjusted HR=0.6, 95% CI, 0.4-1.0 (0.98)], with decreasing point estimates over time. Gastric bypass was followed by a strongly decreased adjusted risk of esophageal adenocarcinoma (HR=0.3, 95% CI, 0.1-0.8) but not of cardia adenocarcinoma (HR=0.9, 95% CI, 0.5-1.6), when analyzed separately. There were no consistent associations between other bariatric procedures (mainly gastroplasty, gastric banding, sleeve gastrectomy, and biliopancreatic diversion) and ECA.Gastric bypass surgery may counteract the development of esophageal adenocarcinoma in morbidly obese individuals.
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