Surgical Health Outcomes Consortium (SHOC), Adventhealth Medical Group Colorectal Surgery, 2415 North Orange Av. Office 102., AdventHealth, Orlando, FL, USA.
Mayo Clinic, Division of Gastroenterology and Hepatology, Jacksonville, FL, USA.
Updates Surg. 2023 Aug;75(5):1051-1057. doi: 10.1007/s13304-023-01527-2. Epub 2023 May 13.
The aim of this meta-analysis is to determine the impact of bariatric surgery on the risk of early-onset colorectal neoplasia. This systematic review was conducted according to PRISMA recommendations. It was registered in the PROSPERO international database. A comprehensive search was conducted in electronic databases (MEDLINE, EMBASE, and Web of Science) for completed studies until May 2022. The Search was made using a mixture of indexed terms and title, abstract and keywords. The search included terms: obese, surgical weight loss intervention, colorectal cancer, and colorectal adenomas. Studies that included bariatric intervention patient's vs non-surgical obese patients younger than 50 years were considered. Inclusion criteria were patients with BMI more than 35 kg/m who underwent a colonoscopy. Studies with follow-up colonoscopy performed in less than 4 years after bariatric surgery and those that evaluated patients with a mean age difference of 5 or more years between groups were excluded. Outcomes analyzed in obese patients with surgical treatment vs control patients included colorectal cancer incidence. From 2008 to 2021, a total of 1536 records were identified. Five retrospective studies that included 48,916 patients were analyzed. Follow-up period ranged from 5 to 22.2 years. 20,663 (42.24%) patients underwent bariatric surgery and 28,253 (57.76%) were part of the control patients. Roux-en-Y gastric bypass was performed in 14,400 (69.7%) individuals. The intervention and control group were similar in age range, proportion of female participants and initial body mass index (35-48.3 vs 35-49.3, respectively). 126/20663 (0.61%) patients in the bariatric surgery group and 175/28253 (0.62%) individuals in the control group presented CRC. In this meta-analysis, we were unable to demonstrate a significant impact of the Bariatric Surgery on EOCRC risk. Prospective trials with longer follow-up periods should be done to prove the colorectal cancer risk reduction.
本荟萃分析旨在确定减重手术对早发性结直肠肿瘤风险的影响。本系统评价按照 PRISMA 建议进行。它在 PROSPERO 国际数据库中进行了注册。截至 2022 年 5 月，在电子数据库（MEDLINE、EMBASE 和 Web of Science）中进行了全面检索，检索到的研究已经完成。检索使用了索引术语和标题、摘要和关键词的混合。检索包括以下术语：肥胖、手术减肥干预、结直肠癌和结直肠腺瘤。纳入了对年龄小于 50 岁的接受减重干预的患者与非手术肥胖患者进行比较的研究。纳入标准为 BMI 大于 35kg/m²且接受结肠镜检查的患者。排除了在减重手术后 4 年内进行结肠镜检查随访的研究，以及评估组间平均年龄差异超过 5 岁的患者的研究。在接受手术治疗的肥胖患者与对照组患者中分析的结局包括结直肠癌发病率。2008 年至 2021 年，共确定了 1536 条记录。分析了 5 项回顾性研究，共纳入 48916 例患者。随访时间为 5 至 22.2 年。20663（42.24%）例患者接受了减重手术，28253（57.76%）例患者为对照组。14400（69.7%）例患者接受了 Roux-en-Y 胃旁路手术。干预组和对照组在年龄范围、女性参与者比例和初始体重指数（分别为 35-48.3 与 35-49.3）方面相似。在减重手术组的 20663 例患者中，有 126 例（0.61%）出现 CRC；在对照组的 28253 例患者中，有 175 例（0.62%）出现 CRC。在本荟萃分析中，我们未能证明减重手术对 EOCRC 风险有显著影响。应该进行随访时间更长的前瞻性试验，以证明结直肠癌风险降低。
