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The influence of antireflux surgery on esophageal cancer risk in England: national population-based cohort study

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Title: The influence of antireflux surgery on esophageal cancer risk in England: national population-based cohort study
Authors: Markar, SR
Arhi, C
Leusink, A
Vidal-Diez, A
Karthikesalingam, A
Darzi, A
Lagergren, J
Hanna, GB
Item Type: Journal Article
Abstract: OBJECTIVE: To evaluate how antireflux surgery influences the risk of esophageal cancer in patients with gastroesophageal reflux disease (GERD) and Barrett esophagus. BACKGROUND: GERD is a major risk factor for esophageal adenocarcinoma, and the United Kingdom has the highest incidence of esophageal adenocarcinoma globally. METHODS: Hospital Episode Statistics database was used to identify all patients in England aged over 18 years diagnosed with GERD with or without Barrett Esophagus from 2000 to 2012, with antireflux surgery being the exposure investigated. The Clinical Practice Research Datalink (CPRD) was used to provide a sensitivity analysis comparing proton pump inhibitor therapy and antireflux surgery. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Cox proportional hazards model with inverse probability weights based on the probability of having surgery to adjust for selection bias and confounding factors. RESULTS: (i) Hospital Episode Statistics analysis; among 838,755 included patients with GERD and 28,372 with Barrett esophagus, 22,231 and 737 underwent antireflux surgery, respectively. In GERD patients, antireflux surgery reduced the risk of esophageal cancer (HR = 0.64; 95% CI 0.52-0.78). In Barrett esophagus patients, the corresponding HR was (HR = 0.47; 95% CI 0.12-1.90).(ii) CPRD analysis; antireflux surgery was associated with decreased point estimates of esophageal adenocarcinoma in patients with GERD (0% vs. 0.2%; P = 0.16) and Barrett esophagus (HR = 0.75; 95% CI 0.21-2.63), but these were not statistically significant. CONCLUSION: Antireflux surgery may be associated with a reduced risk of esophageal cancer risk, however it remains primarily an operation for symptomatic relief.
Issue Date: Nov-2018
Date of Acceptance: 5-Jun-2018
URI: http://hdl.handle.net/10044/1/61672
DOI: https://dx.doi.org/10.1097/SLA.0000000000002890
ISSN: 0003-4932
Publisher: Lippincott, Williams & Wilkins
Start Page: 861
End Page: 867
Journal / Book Title: Annals of Surgery
Volume: 268
Issue: 5
Copyright Statement: © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Sponsor/Funder: National Institute of Health Research
Keywords: Science & Technology
Life Sciences & Biomedicine
antireflux surgery
esophageal neoplasm
gastro-esophageal reflux disease
11 Medical and Health Sciences
Publication Status: Published
Conference Place: United States
Online Publication Date: 2018-11-01
Appears in Collections:Department of Surgery and Cancer
Institute of Global Health Innovation