Obesity surgery and risk of cancer
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
BACKGROUND: Obesity increases the risk of several types of cancer. Whether bariatric surgery influences the risk of obesity-related cancer is not clear. This study aimed to uncover the risk of hormone-related (breast, endometrial and prostate), colorectal and oesophageal cancers following obesity surgery. METHODS: This national population-based cohort study used data from the Hospital Episode Statistics database in England collected between 1997 and 2012. Propensity matching on sex, age, co-morbidity and duration of follow-up was used to compare cancer risk among obese individuals undergoing bariatric surgery (gastric bypass, gastric banding or sleeve gastrectomy) and obese individuals not undergoing such surgery. Conditional logistic regression provided odds ratios (ORs) with 95 per cent confidence intervals. RESULTS: In the study period, from a cohort of 716 960 patients diagnosed with obesity, 8794 patients who underwent bariatric surgery were matched exactly with 8794 obese patients who did not have surgery. Compared with the no-surgery group, patients who had bariatric surgery exhibited a decreased risk of hormone-related cancers (OR 0·23, 95 per cent c.i. 0·18 to 0·30). This decrease was consistent for breast (OR 0·25, 0·19 to 0·33), endometrium (OR 0·21, 0·13 to 0·35) and prostate (OR 0·37, 0·17 to 0·76) cancer. Gastric bypass resulted in the largest risk reduction for hormone-related cancers (OR 0·16, 0·11 to 0·24). Gastric bypass, but not gastric banding or sleeve gastrectomy, was associated with an increased risk of colorectal cancer (OR 2·63, 1·17 to 5·95). Longer follow-up after bariatric surgery strengthened these diverging associations. CONCLUSION: Bariatric surgery is associated with decreased risk of hormone-related cancers, whereas gastric bypass might increase the risk of colorectal cancer.
Date Issued
2018-11
Date Acceptance
2018-05-17
Citation
British Journal of Surgery, 2018, 105 (12), pp.1650-1657
ISSN
1365-2168
Publisher
Wiley
Start Page
1650
End Page
1657
Journal / Book Title
British Journal of Surgery
Volume
105
Issue
12
Copyright Statement
© 2018 BJS Society Ltd Published by John Wiley & Sons Ltd. This is the accepted version of the following article, which has been published in final form at https://onlinelibrary.wiley.com/doi/abs/10.1002/bjs.10914
Sponsor
National Institute for Health Research
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30003539
Grant Number
NIHR-CTF-2015-04-09
Subjects
Science & Technology
Life Sciences & Biomedicine
Surgery
GASTRIC BYPASS-SURGERY
BARIATRIC SURGERY
ESOPHAGEAL ADENOCARCINOMA
MORTALITY
METAANALYSIS
REFLUX
TRIAL
Adolescent
Adult
Aged
Aged, 80 and over
Bariatric Surgery
Breast Neoplasms
Colorectal Neoplasms
Endometrial Neoplasms
Esophageal Neoplasms
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Neoplasms
Neoplasms, Hormone-Dependent
Obesity
Postoperative Complications
Propensity Score
Prostatic Neoplasms
Risk Factors
Young Adult
Humans
Neoplasms
Breast Neoplasms
Esophageal Neoplasms
Colorectal Neoplasms
Endometrial Neoplasms
Prostatic Neoplasms
Neoplasms, Hormone-Dependent
Obesity
Postoperative Complications
Risk Factors
Adolescent
Adult
Aged
Aged, 80 and over
Middle Aged
Female
Male
Bariatric Surgery
Young Adult
Propensity Score
Kaplan-Meier Estimate
Surgery
11 Medical and Health Sciences
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2018-07-13