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The effect of bariatric surgery on reducing the risk of colorectal cancer: a meta-analysis of 3,233,044 patients

Published:October 11, 2022DOI:https://doi.org/10.1016/j.soard.2022.10.003

      Highlights

      • Patients who underwent bariatric surgery had a 37% reduction in the risk of developing colorectal cancer compared with patients with obesity who had no surgery
      • The sub-analysis of studies with minimum 10 years of follow-up showed 32% decrease in risk of developing colorectal cancer compared with patients with obesity who had no surgery

      Abstract

      Background

      The published literature presents conflicting results regarding the impact of bariatric surgery on the incidence of colorectal cancer. There are important new studies that have addressed this question with longer follow-up.

      Objective

      To investigate the effect of bariatric surgery on the risk of developing colorectal cancer in patients with obesity.

      Setting

      Meta-analysis.

      Methods

      PubMed and Scopus were searched for relevant articles. Articles published by November 2021 were retrieved; data were extracted according to the evidence-based PICO (population, intervention, control, outcome) model and analyzed using a random-effects model to estimate the pooled relative risk (RR) and its 95% confidence interval. The heterogeneity of studies was tested and quantified using Cochran’s Q.

      Results

      The initial search yielded 327 articles. After evaluation, 13 studies were analyzed. The thorough evaluation resulted in 13 articles, which were analyzed. A total number of 3,233,044 patients were included in the meta-analysis. The mean time of follow-up was 9.5 ± 7.9 years. The pooled estimate of the adjusted RR was .63 (95% confidence interval, .50–.79). Heterogeneity χ2 was 107.96 (df = 12; P < .001; I2 = 89%).

      Conclusion

      Patients who underwent bariatric surgery had a 37% reduction in the risk of developing colorectal cancer compared with patients with obesity who had no surgery.

      Keywords

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      References

        • Schauer P.R.
        • Bhatt D.L.
        • Kirwan J.P.
        • et al.
        Bariatric surgery versus intensive medical therapy for diabetes: 5-year outcomes.
        N Engl J Med. 2017; 376: 641-651
        • Steele C.B.
        • Thomas C.C.
        • Henley S.J.
        • et al.
        Vital signs: trends in incidence of cancers associated with overweight and obesity — United States, 2005–2014.
        MMWR Morb Mortal Wky Rep. 2017; 66: 1052-1058
        • Adams K.F.
        • Schatzkin A.
        • Harris T.B.
        • et al.
        Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old.
        N Engl J Med. 2006; 355: 763-778
        • Lauby-Secretan B.
        • Scoccianti C.
        • Loomis D.
        • Grosse Y.
        • Bianchini F.
        • Straif K.
        Body fatness and cancer—viewpoint of the IARC Working Group.
        N Engl J Med. 2016; 375: 794-798
        • Gribovskaja-Rupp I.
        • Kosinski L.
        • Ludwig K.A.
        Obesity and colorectal cancer.
        Clin Colon Rectal Surg. 2011; 24: 229-243
        • Dong Y.
        • Zhou J.
        • Zhu Y.
        • et al.
        Abdominal obesity and colorectal cancer risk: systematic review and meta-analysis of prospective studies.
        Biosci Rep. 2017; 37BSR20170945
        • Bailly L.
        • Fabre R.
        • Pradier C.
        • Iannelli A.
        Colorectal cancer risk following bariatric surgery in a nationwide study of french individuals with obesity.
        JAMA Surg. 2020; 155: 395-402
        • Taube M.
        • Peltonen M.
        • Sjöholm K.
        • et al.
        Long-term incidence of colorectal cancer after bariatric surgery or usual care in the Swedish Obese Subjects study.
        PLoS One. 2021; 16e0248550
        • Almazeedi S.
        • El-Abd R.
        • Al-Khamis A.
        • Albatineh A.N.
        • Al-Sabah S.
        Role of bariatric surgery in reducing the risk of colorectal cancer: a meta-analysis.
        Br J Surg. 2020; 107: 348-354
        • Afshar S.
        • Kelly S.B.
        • Seymour K.
        • Lara J.
        • Woodcock S.
        • Mathers J.C.
        The effects of bariatric surgery on colorectal cancer risk: systematic review and meta-analysis.
        Obes Surg. 2014; 24: 1793-1799
        • Ciccioriccio M.C.
        • Iossa A.
        • Boru C.E.
        • et al.
        Colorectal cancer after bariatric surgery (Cric-Abs 2020): Sicob (Italian society of obesity surgery) endorsed national survey.
        Int J Obes (Lond). 2021; 45: 2527-2531
        • Khalid S.I.
        • Maasarani S.
        • Wiegmann J.
        • et al.
        Association of bariatric surgery and risk of cancer in patients with morbid obesity.
        Ann Surg. 2022; 275: 1-6
        • Tsui S.T.
        • Yang J.
        • Zhang X.
        • et al.
        Development of cancer after bariatric surgery.
        Surg Obes Relat Dis. 2020; 16: 1586-1595
        • Kwak M.
        • Mehaffey J.H.
        • Hawkins R.B.
        • et al.
        Bariatric surgery is independently associated with a decrease in the development of colorectal lesions.
        Surgery. 2019; 166: 322-326
        • Derogar M.
        • Hull M.A.
        • Kant P.
        • Östlund M.
        • Lu Y.
        • Lagergren J.
        Increased risk of colorectal cancer after obesity surgery.
        Ann Surg. 2013; 258: 983-988
        • Zhang H.
        • DiBaise J.K.
        • Zuccolo A.
        • et al.
        Human gut microbiota in obesity and after gastric bypass.
        Proc Natl Acad Sci U S A. 2009; 106: 2365-2370
        • Rebecchi F.
        • Allaix M.E.
        • Ugliono E.
        • Giaccone C.
        • Toppino M.
        • Morino M.
        Increased esophageal exposure to weakly acidic reflux 5 years after laparoscopic Roux-en-Y gastric bypass.
        Ann Surg. 2016; 264: 871-877
        • El Ghoch M.
        • Calugi S.
        • Dalle Grave R.
        Increased risk of colorectal cancer after obesity surgery.
        Ann Surg. 2015; 262: e15
        • Derogar M.
        • Hull M.
        • Kant P.
        • Lu Y.
        • Lagergren J.
        Reply to letter: “Increased risk of colorectal cancer after obesity surgery”.
        Ann Surg. 2015; 262: e15-e16
        • Mackenzie H.
        • Markar S.R.
        • Askari A.
        • et al.
        Obesity surgery and risk of cancer.
        Br J Surg. 2018; 105: 1650-1657
        • Aravani A.
        • Downing A.
        • Thomas J.D.
        • Lagergren J.
        • Morris E.J.A.
        • Hull M.A.
        Obesity surgery and risk of colorectal and other obesity-related cancers: an English population-based cohort study.
        Cancer Epidemiol. 2018; 53: 99-104
        • Colquitt J.
        • Pickett K.
        • Loveman E.
        • Frampton G.
        Surgery for weight loss in adults.
        Cochrane Database Syst Rev. 2014; 8: CD003641
        • O’Callaghan N.J.
        • Clifton P.M.
        • Noakes M.
        • Fenech M.
        Weight loss in obese men is associated with increased telomere length and decreased abasic sites in rectal mucosa.
        Rejuvenation Res. 2009; 12: 169-176
        • Rao S.R.
        Inflammatory markers and bariatric surgery: a meta-analysis.
        Inflamm Res. 2012; 61: 789-807
        • Afshar S.
        • Malcomson F.
        • Kelly S.B.
        • Seymour K.
        • Woodcock S.
        • Mathers J.C.
        Biomarkers of colorectal cancer risk decrease 6 months after Roux-en-Y gastric bypass surgery.
        Obes Surg. 2018; 28: 945-954
        • Christou N.V.
        • Lieberman M.
        • F. Sampalis.
        • J.S Sampalis.
        Bariatric surgery reduces cancer risk in morbidly obese patients.
        Surg Obes Relat Dis. 2008; 4: 691-695
        • Adams T.D.
        • Stroup A.M.
        • Gress R.E.
        • et al.
        Cancer incidence and mortality after gastric bypass surgery.
        Obesity (Silver Spring). 2009; 17: 796-802
        • McCawley G.M.
        • Ferriss J.S.
        • Geffel D.
        • Northup C.J.
        • Modesitt S.C.
        Cancer in obese women: potential protective impact of bariatric surgery.
        J Am Coll Surg. 2009; 208: 1093-1098
        • Schauer D.P.
        • Feigelson H.S.
        • et al.
        Bariatric Surgery and the Risk of Cancer in a Large Multisite Cohort.
        Ann Surg. 2019; 269: 95-101
        • Tao W.
        • Artama M.
        • et al.
        Colon and rectal cancer risk after bariatric surgery in a multicountry Nordic cohort study.
        Int J Cancer. 2020; 147: 728-735