Bariatric surgery reduces the risk of cancer and death

Bariatric surgery reduces the risk of cancer and death

Researchers report that weight loss, achieved even through bariatric surgery, reduced the risks of obesity-related cancers.

In a study of more than 30,000 adults with obesity, only 2.9% of those who chose bariatric surgery were diagnosed with cancer during the 10-year follow-up versus 4.9% of the non-surgical controls (absolute risk difference 2.0%, 95% CI 1.2% – 2.7%) , according to Stephen E. Nissen, MD, of the Cleveland Clinic, and colleagues.

This translates to an incidence rate of 3.0 events versus 4.6 events per 1,000 person-years, respectively, and a 32% reduced risk of obesity-related cancer after weight loss from bariatric surgery (adjusted heart rate 0.68, 95% CI 0.53–0.87, s= 0.002).

Obesity-related cancer was a composite of these thirteen types of cancer: esophageal cancer, renal cell carcinoma, postmenopausal breast cancer (diagnosed at age 55) or breast cancer in younger patients who underwent bilateral oophorectomy, multiple myeloma, And cancers of the heart, colon, rectum, liver, gallbladder, pancreas, ovary, uterine body, and thyroid gland.

Findings from Surgical Procedures and Long-Term Efficacy in Oncology and Death (SPLENDID) were presented at the American Diabetes Association (ADA) Annual Meeting and published in Gamma.

The co-author said: “Patients can lose 20-40% of their weight after surgery, and the weight loss can continue over decades. The amazing results of this study suggest that the greater the weight loss, the lower the risk of cancer.” Ali Aminian, MD, a physician at the Cleveland Clinic, said in a statement.

The risk of all types of cancer was also significantly lower for patients who underwent bariatric surgery (HR 0.83, 95% CI 0.69-0.99, s= 0.04).

Nissen’s group included patients who underwent the two most common bariatric procedures today: gastric bypass and sleeve gastrectomy. Compared with non-surgical obesity care, both procedures were linked to a lower risk of cancer and there was no significant difference between the two types of procedures:

  • Roux-en-Y: 0.70 aHR (95% CI 0.53-0.92)
  • Sleeve gastrectomy: 0.66 aHR (95% CI 0.44-1.00)

The benefits of bariatric surgery have also extended to cancer-related deaths. Only 21 patients who underwent bariatric surgery died of cancer compared to 205 patients in the non-operative group (incidence rate of 0.6 events versus 1.2 events, respectively, per 1000 person-years).

During the decade-long follow-up, this translated to a cumulative cancer-related mortality rate of 0.8% in the bariatric surgery group versus 1.4% in the nonsurgical control group.

Overall, bariatric surgery was associated with a 48% reduced risk of cancer-related death (adjusted heart rate (HRR) 0.52, 95% confidence interval (CI) 0.31–0.88, s= 0.01).

For certain types of cancer, the most common types of cancer among these patients included breast cancer and endometrial cancer. Compared with nonsurgical controls, bariatric surgery was linked to a 53% lower risk of endometrial cancer (aHR 0.47, 95% CI 0.27-0.83).

“Obesity, according to the American Cancer Society, is second only to tobacco as a preventable cause of cancer in the United States,” Nissen said in a statement. “This study provides the best possible evidence of the value of intentional weight loss to reduce cancer risks and mortality.”

Although this is not the first study to demonstrate the preventive benefits of bariatric surgery, “it does provide further support for the findings that people who undergo bariatric surgery may have a lower risk of developing cancer,” writes Anita P. MPH, of the University of Michigan Medical Center. Pittsburgh, in an accompanying editorial.

A total of 30318 patients with mean ages and BMIs of 46 and 45, respectively, were included. The majority of the group was white and, as expected, the proportion of females was 77%. Of the 5,053 patients who chose bariatric surgery, 66% underwent Roux-en-Y gastric bypass and 34% underwent sleeve gastrectomy.

At the 10-year mark, patients who underwent bariatric surgery lost 60.6 pounds (27.5 kg), while non-surgical controls lost only 6 pounds (2.7 kg) on ​​average.

“Bariatric surgery is the only currently available treatment that can provide this volume and durability for weight loss,” the researchers noted. They point to the Look AHEAD study, which found that weight loss from an intensive lifestyle intervention did not result in sufficient weight loss to reduce obesity-related cancer risk or mortality.

Korculas noted that more research is still needed on this topic, which may require a randomized clinical trial. “It may be practical to consider such randomized clinical trials among patients at high risk of developing certain types of cancer, such as women at high risk of endometrial or breast cancer,” she noted.

  • Christine Monaco is a staff writer, focusing on endocrinology, psychiatry and nephrology news. Out of a New York City office, I’ve worked for the company since 2015.

Disclosures

Nissen has reported its relationships with Novartis, Eli Lilly, AbbVie, Silence Therapeutics, AstraZeneca, Esperion Therapeutics, Amgen and Bristol Myers Squibb. Other co-authors also reported the disclosures.

2022-06-03 19:09:24

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