Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland.
Diabetes Care. 2022 Sep 1;45(9):1981-1986. doi: 10.2337/dc22-0485.
Bariatric surgery prolongs life expectancy in severely obese individuals, but it is uncertain which of the two dominating bariatric procedures, sleeve gastrectomy or gastric bypass, offers the best long-term survival.
This was a population-based cohort study of primary laparoscopic sleeve gastrectomy compared with gastric bypass for obesity in Sweden and Finland between 1 January 2007 and 31 December 2020. The risk of all-cause mortality was calculated using multivariable Cox regression, providing hazard ratios (HRs) with 95% CIs adjusted for age, sex, hypertension, diabetes, Charlson comorbidity index, country, and calendar year.
Among 61,503 patients (median age 42 years; 75.4% women), who contributed 415,712 person-years at risk (mean 6.8 person-years), 1,571 (2.6%) died during follow-up. Compared with patients who underwent gastric bypass (n = 51,891 [84.4%]), the sleeve gastrectomy group (n = 9,612 [15.6%]) had similar all-cause mortality during the entire study period (HR 0.98, 95% CI 0.81-1.20), but decreased all-cause mortality in more recent years (HR 0.72, 95% CI 0.54-0.97, from 2014 onward). Diabetes interacted statistically significantly with the type of bariatric surgery, with higher all-cause mortality after sleeve gastrectomy than after gastric bypass (HR 1.54, 95% CI 1.06-2.24).
The overall survival following sleeve gastrectomy seems to compare well with gastric bypass and may even be better during recent years. A tailored surgical approach in relation to patients' diabetes status may optimize survival in patients selected for bariatric surgery (i.e., sleeve gastrectomy for patients without diabetes and gastric bypass for patients with diabetes).
减重手术可延长重度肥胖患者的预期寿命，但目前尚不确定两种主要的减重手术（胃袖状切除术和胃旁路术）中哪一种提供最佳的长期生存。
这是一项基于人群的队列研究，比较了瑞典和芬兰在 2007 年 1 月 1 日至 2020 年 12 月 31 日期间进行的腹腔镜下胃袖状切除术与胃旁路术治疗肥胖症的效果。使用多变量 Cox 回归计算全因死亡率，提供经过年龄、性别、高血压、糖尿病、Charlson 合并症指数、国家和日历年调整的危险比（HR）及其 95%置信区间。
在 61503 例患者（中位年龄 42 岁，75.4%为女性）中，共随访 415712 人年（平均随访 6.8 人年），随访期间有 1571 例（2.6%）死亡。与接受胃旁路术的患者（n=51891[84.4%]）相比，接受胃袖状切除术的患者（n=9612[15.6%]）在整个研究期间全因死亡率相似（HR 0.98，95%CI 0.81-1.20），但在最近几年全因死亡率降低（HR 0.72，95%CI 0.54-0.97，自 2014 年起）。糖尿病与减重手术的类型存在统计学显著交互作用，胃袖状切除术的全因死亡率高于胃旁路术（HR 1.54，95%CI 1.06-2.24）。
胃袖状切除术的总体生存率似乎与胃旁路术相当，在最近几年甚至可能更好。根据患者糖尿病状况制定个体化手术方法可能会优化接受减重手术患者的生存（即无糖尿病患者行胃袖状切除术，有糖尿病患者行胃旁路术）。
