Département de Santé Publique, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France.
EA Cobtek, Université Côte d'Azur, Nice, France.
JAMA Surg. 2020 May 1;155(5):395-402. doi: 10.1001/jamasurg.2020.0089.
Although bariatric surgery is effective against morbid obesity, the association of this surgery with the risk of colorectal cancer remains controversial.
To assess whether bariatric surgery is associated with altered risk of colorectal cancer among individuals with obesity.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, population-based, multicenter, cohort study based on French electronic health data included 1 045 348 individuals with obesity, aged 50 to 75 years, and free of colorectal cancer at baseline. All inpatients with obesity having data recorded during a hospital stay between 2009 and 2018 by the French national health insurance information system database were followed up for a mean (SD) of 5.3 (2.1) years for those who did not undergo bariatric surgery and 5.7 (2.2) years for those who underwent bariatric surgery. Two groups of patients comparable in terms of age, sex, body mass index, follow-up, comorbidities, and conditions who did or did not undergo surgery were also obtained by propensity score matching.
Bariatric surgery (n = 74 131), including adjustable gastric banding, sleeve gastrectomy, gastric bypass; or no bariatric surgery (n = 971 217).
Primary outcome was incident colorectal cancer. Standardized incidence ratios were calculated using age-, sex-, and calendar year-matched colorectal cancer incidence among the general French population during the corresponding years. Secondary outcome was incident colorectal benign polyps.
Among a total of 1 045 348 patients, the mean (SD) age was 57.3 (5.5) years for the 74 131 patients in the surgical cohort vs 63.4 (7.0) years for the 971 217 patients in the nonsurgical cohort. The mean (SD) follow-up was 6.2 (2.1) years for patients who underwent adjustable gastric banding, 5.5 (2.1) years for patients who underwent sleeve gastrectomy, and 5.7 (2.2) years for patients who underwent gastric bypass. In total, 13 052 incident colorectal cancers (1.2%) and 63 649 colorectal benign polyps were diagnosed. The rate of colorectal cancer was 0.6% in the bariatric surgery cohort and 1.3% in the cohort without bariatric surgery. In the latter cohort, 9417 cases were expected vs 12 629 observed, a standardized incidence ratio of 1.34 (95% CI, 1.32-1.36). In the bariatric surgery cohort, 428 cases were expected and 423 observed, a standardized incidence ratio of 1.0 (95% CI, 0.90-1.09). Propensity score-matched hazard ratios in comparable operated vs nonoperated groups were 0.68 (95% CI, 0.60-0.77) for colorectal cancer and 0.56 (95% CI, 0.53-0.59) for colorectal benign polyp. There were fewer new diagnoses of colorectal cancer after gastric bypass (123 of 22 343 [0.5%]) and sleeve gastrectomy (185 of 35 328 [0.5%]) than after adjustable gastric banding (115 of 16 460 [0.7%]), and more colorectal benign polyps after adjustable gastric banding (775 of 15 647 [5.0%]) than after gastric bypass (639 of 20 863 [3.1%]) or sleeve gastrectomy (1005 of 32 680 [3.1%]).
The results of this nationwide cohort study suggested that following bariatric surgery, patients with obesity share the same risk of colorectal cancer as the general population, whereas for patients with obesity who do not undergo bariatric surgery, the risk is 34% above that of the general population.
尽管减肥手术对病态肥胖症有效，但该手术与结直肠癌风险的关联仍存在争议。
评估减肥手术是否会改变肥胖人群患结直肠癌的风险。
设计、地点和参与者：这项基于法国电子健康数据的回顾性、基于人群的、多中心队列研究包括 1045348 名年龄在 50 至 75 岁之间、基线时无结直肠癌的肥胖患者。所有因肥胖住院的住院患者，在法国国家健康保险信息系统数据库中记录了 2009 年至 2018 年期间的住院数据，未接受减肥手术的患者平均（SD）随访时间为 5.3（2.1）年，接受减肥手术的患者为 5.7（2.2）年。还通过倾向评分匹配获得了两组在年龄、性别、体重指数、随访、合并症和条件方面可比的患者，一组为手术组，另一组为非手术组。
减肥手术（n=74131），包括可调胃束带、胃袖状切除术、胃旁路术；或无减肥手术（n=971217）。
主要结果是结直肠癌的发病情况。使用同期法国普通人群中年龄、性别和日历年龄匹配的结直肠癌发病率计算标准化发病比。次要结果是结直肠良性息肉的发病情况。
在总计 1045348 名患者中，手术组的 74131 名患者的平均（SD）年龄为 57.3（5.5）岁，非手术组的 971217 名患者的平均（SD）年龄为 63.4（7.0）岁。接受可调胃束带治疗的患者平均（SD）随访时间为 6.2（2.1）年，接受胃袖状切除术的患者为 5.5（2.1）年，接受胃旁路术的患者为 5.7（2.2）年。共有 13052 例结直肠癌（1.2%）和 63649 例结直肠良性息肉被诊断。在减肥手术组中，结直肠癌的发病率为 0.6%，在未接受减肥手术的组中为 1.3%。在后一组中，预期有 9417 例，观察到 12629 例，标准化发病率比为 1.34（95%CI，1.32-1.36）。在减肥手术组中，预期有 428 例，观察到 423 例，标准化发病率比为 1.0（95%CI，0.90-1.09）。在可比的手术组与非手术组中，手术后结直肠癌的风险比为 0.68（95%CI，0.60-0.77），结直肠良性息肉的风险比为 0.56（95%CI，0.53-0.59）。胃旁路术（115 例[0.5%]）和胃袖状切除术（185 例[0.5%]）后结直肠癌的新诊断病例少于可调胃束带（123 例[0.7%]），可调胃束带（775 例[5.0%]）后结直肠良性息肉的新诊断病例多于胃旁路术（639 例[3.1%]）或胃袖状切除术（1005 例[3.1%]）。
这项全国性队列研究的结果表明，减肥手术后，肥胖患者与普通人群的结直肠癌风险相同，而对于未接受减肥手术的肥胖患者，风险比普通人群高 34%。
