Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada.
Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada.
Surg Obes Relat Dis. 2021 May;17(5):879-887. doi: 10.1016/j.soard.2020.12.011. Epub 2020 Dec 29.
Sleeve gastrectomy (SG) is the most common bariatric surgery; however, this approach may induce gastroesophageal reflux disease (GERD). Both obesity and GERD are independent risk factors for esophageal cancer, however the impact of SG on risk of esophageal cancer remains unknown.
To evaluate the risk of esophageal cancer after reflux-prone bariatric surgery.
Population-level, provincial administrative healthcare database, Quebec, Canada.
We identified a population-based cohort of all patients with obesity who underwent reflux-prone surgery (SG and duodenal switch [DS]) or reflux-protective Roux-en-Y gastric bypass (RYGB) during 01/2006-12/2012 in Quebec, Canada. For every surgical patient, 2-3 nonsurgical controls with obesity matched for age, sex, and geography were also identified. Crude incidence rate ratios (IRRs) for esophageal cancer were calculated using person-time analysis. Hazard ratios (HRs) were obtained using multivariate cox regression.
A total of 4121 patients had reflux-prone procedures and 852 underwent RYGB. At a mean follow-up of 7.6 years, 8 cases of esophageal cancer were identified after bariatric surgery. Compared with RYGB, IRR for esophageal cancer in reflux-prone group was 1.45 (95%CI: .19-65.5) and HR = .83 (95%CI: .10-7.27). The crude incidence rate of esophageal cancer in the reflux-prone group was higher than that of nonsurgical controls (n = 12,159; IRR = 3.46, 95%CI: 1.00-12.5), but after adjustment the difference disappeared (HR = 2.47, 95%CI: .82-7.45).
Long-term incidence of esophageal cancer after reflux-prone bariatric surgery is not greater than RYGB. While crude incidence of esophageal cancer after reflux-prone surgery is higher than in nonsurgical patients with obesity, such difference disappears after accounting for confounders. Given the low incidence of esophageal cancer and slow progression of dysplastic Barrett esophagus, studies with longer follow-up are needed.
袖状胃切除术（SG）是最常见的减肥手术；然而，这种方法可能会引发胃食管反流病（GERD）。肥胖和 GERD 都是食管癌的独立危险因素，然而 SG 对食管癌风险的影响尚不清楚。
评估易发生反流的减肥手术后食管癌的风险。
人群水平，省级行政医疗保健数据库，加拿大魁北克省。
我们在加拿大魁北克省确定了一个基于人群的肥胖患者队列，他们在 2006 年 1 月至 2012 年 12 月期间接受了易发生反流的手术（SG 和十二指肠转位术 [DS]）或反流保护 Roux-en-Y 胃旁路术（RYGB）。对于每例手术患者，还按年龄、性别和地理位置匹配了 2-3 例肥胖的非手术对照。使用个体时间分析计算食管癌的粗发病率比值（IRR）。使用多变量 cox 回归获得危险比（HR）。
共有 4121 例患者接受了易发生反流的手术，852 例接受了 RYGB。在平均 7.6 年的随访中，在减肥手术后发现了 8 例食管癌。与 RYGB 相比，易发生反流组食管癌的 IRR 为 1.45（95%CI：.19-65.5），HR =.83（95%CI：.10-7.27）。易发生反流组的食管癌粗发病率高于非手术对照组（n = 12159；IRR = 3.46，95%CI：1.00-12.5），但调整后差异消失（HR = 2.47，95%CI：.82-7.45）。
易发生反流的减肥手术后食管癌的长期发病率并不高于 RYGB。虽然易发生反流的减肥手术后食管癌的粗发病率高于肥胖的非手术患者，但在考虑混杂因素后，这种差异消失。鉴于食管癌的发病率较低且异型性 Barrett 食管的进展缓慢，需要进行随访时间更长的研究。
