Association of Bariatric Surgery and Risk of Cancer in Patients With Morbid Obesity

Syed I. Khalid, MD; Samantha Maasarani, MD, MPH; Julia Wiegmann, MSCR; Aaron L. Wiegmann, MD, MS; Adan Z. Becerra, PhD; Philip Omotosho, MD; Alfonso Torquati, MD

Disclosures

Annals of Surgery. 2022;275(1):1-6. 

In This Article

Results

Descriptive Characteristics

Between January 1st, 2010 and June 30th, 2018, 2,150,646 patients were identified as meeting the criteria for bariatric surgery—1,578,275 patients did not have benefits enrollment for our 5-year follow-up period and were therefore excluded from our study. A total of 572,371 bariatric-eligible patients with benefits enrollment for five years were identified and included in our study (Figure 1). The descriptive characteristics of the total unmatched population are summarized in Supplemental Table 4, http://links.lww.com/SLA/D232.

Figure 1.

Patient selection flow chart.

The exact matched population analyzed in this study contained a total of 28,908 bariatric-eligible patients equally split into patients undergoing VSG (n = 9636, 33.3%), undergoing RYGB (n = 9636, 33.3%), and those with no surgical intervention (n = 9636, 33.3%). The descriptive characteristics and postoperative cancer rates for these cohorts are summarized in Table 1. Each cohort consisted of exactly 7914 females (82.13%) and 1722 males (17.87%) with >50% of bariatric-eligible patients between the ages of 35 and 54. Comorbidities were equally represented, with each cohort composed of 50.71% hypertension, 41.30% T2DM, 38.07% obstructive sleep apnea, 29.94% osteoarthritis, 20.02% chronic obstructive pulmonary disease, 13.84% smoking, 6.27% coronary artery disease, 1.65% chronic kidney disease, 1.68% congestive heart failure, and 3.25% nonalcoholic fatty liver disease (Table 1).

Impact of Bariatric Surgical Procedures on Future Cancer Development

A total of 1127 patients developed cancer within our 5-year follow-up period with breast (n = 409, 1.41%), uterine (n = 195, 0.67%), and thyroid (n = 134, 0.46%) cancer being the most common types. Bariatric-eligible patients that did not undergo surgical intervention had statistically significant higher rates of developing any cancer type (4.61% vs 3.47% vs 3.62%; P < 0.0005), obesity-related cancers (4.82% vs 3.48% vs 3.52%, P < 0.0005), and non–obesity-related cancers (0.64% vs 0.37% vs 0.51%, P = 0.003) within 5 years when compared to VSG and RYGB. Additionally, the nonsurgical cohort had higher rates of colorectal (0.57% vs 0.42% vs 0.27%; P = 0.002), liver (0.26% vs 0.11% vs 0.15%; P = 0.013), lung (0.50% vs 0.21% vs 0.24%; P = 0.001), ovarian (0.43% vs 0.18% vs 0.15%; P = 0.001), and uterine cancer (0.86% vs 0.56% vs 0.60%; P = 0.007) within 5 years when compared to VSG and RYGB cohorts, respectively. There was no significant difference in the five-year rates of breast, esophageal, gallbladder, gastric, meningioma, multiple myeloma, pancreatic, prostate, renal, or thyroid cancer (Table 1).

Furthermore, VSG and RYGB reduced the odds of developing any cancer type by 25.7% and 22.2%, respectively (VSG: OR 0.74, 95% CI 0.64–0.86; RYGB: OR 0.78, 95% CI 0.67–0.90) and obesity-related cancers by 29% and 28%, respectively (VSG: OR 0.71, 95% CI 0.62–0.82; RYGB: OR 0.72, 95% CI 0.62–0.83). Additionally, both types of bariatric surgical intervention were associated with reduced odds of developing lung (VSG: OR 0.42, 95% CI 0.25–0.70; RYGB: OR 0.48, 95% CI 0.29–0.79), ovarian (VSG: OR 0.41, 95% CI 0.24–0.73; RYGB: OR 0.34, 95% CI 0.19–0.63), and uterine cancers (VSG: OR 0.65, 95% CI 0.46–0.92; RYGB: OR 0.70, 95% CI 0.50–0.98). However, a reduction in odds of developing colorectal cancer was only seen in individuals undergoing RYGB (OR 0.47, 95% CI 0.30–0.75). Similarly, the odds of developing non–obesity-related cancers (OR 0.58, 95% CI 0.38–0.87) and liver cancer (OR 0.44, 95% CI 0.22–0.89) were only reduced among the VSG cohort. There was no significant difference in odds of developing breast, esophageal, gallbladder, gastric, meningioma, multiple myeloma, pancreatic, prostate, renal, or thyroid cancers (Table 2).

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