Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Karolinska University Hospital, Sweden.
Department of Public Health, University of Copenhagen, Denmark.
Ann Surg. 2023 Dec 1;278(6):904-909. doi: 10.1097/SLA.0000000000006003. Epub 2023 Jul 14.
The objective of this study was to test the hypothesis that bariatric surgery decreases the risk of esophageal and cardia adenocarcinoma.
Obesity is strongly associated with esophageal adenocarcinoma and moderately with cardia adenocarcinoma, but whether weight loss prevents these tumors is unknown.
This population-based cohort study included patients with an obesity diagnosis in Sweden, Finland, or Denmark. Participants were divided into a bariatric surgery group and a nonoperated group. The incidence of esophageal and cardia adenocarcinoma (ECA) was first compared with the corresponding background population by calculating standardized incidence ratios (SIR) with 95% CIs. Second, the bariatric surgery group and the nonoperated group were compared using multivariable Cox regression, providing hazard ratios (HR) with 95% CI, adjusted for sex, age, comorbidity, calendar year, and country.
Among 748,932 participants with an obesity diagnosis, 91,731 underwent bariatric surgery, predominantly gastric bypass (n=70,176; 76.5%). The SIRs of ECA decreased over time after gastric bypass, from SIR=2.2 (95% CI, 0.9-4.3) after 2 to 5 years to SIR=0.6 (95% CI, <0.1-3.6) after 10 to 40 years. Gastric bypass patients were also at a decreased risk of ECA compared with nonoperated patients with obesity [adjusted HR=0.6, 95% CI, 0.4-1.0 (0.98)], with decreasing point estimates over time. Gastric bypass was followed by a strongly decreased adjusted risk of esophageal adenocarcinoma (HR=0.3, 95% CI, 0.1-0.8) but not of cardia adenocarcinoma (HR=0.9, 95% CI, 0.5-1.6), when analyzed separately. There were no consistent associations between other bariatric procedures (mainly gastroplasty, gastric banding, sleeve gastrectomy, and biliopancreatic diversion) and ECA.
Gastric bypass surgery may counteract the development of esophageal adenocarcinoma in morbidly obese individuals.
本研究旨在验证假设，即减重手术可降低食管腺癌和贲门腺癌的发病风险。
肥胖与食管腺癌高度相关，与贲门腺癌中度相关，但减重是否可预防这些肿瘤尚不清楚。
本基于人群的队列研究纳入了在瑞典、芬兰或丹麦被诊断为肥胖的患者。参与者分为减重手术组和未手术组。首先通过计算标准化发病比（SIR）及其 95%置信区间（CI），将食管腺癌和贲门腺癌（ECA）的发病率与相应的基础人群进行比较。其次，通过多变量 Cox 回归比较减重手术组和未手术组，提供调整性别、年龄、合并症、日历年份和国家后的风险比（HR）及其 95%CI。
在 748932 名被诊断为肥胖的参与者中，91731 名接受了减重手术，主要为胃旁路手术（n=70176；76.5%）。胃旁路手术后 ECA 的 SIR 随时间逐渐降低，从 2 至 5 年的 SIR=2.2（95%CI，0.9-4.3）降至 10 至 40 年的 SIR=0.6（95%CI，<0.1-3.6）。与肥胖未手术患者相比，胃旁路手术患者 ECA 的发病风险也降低[校正 HR=0.6，95%CI，0.4-1.0（0.98）]，且时间依赖性点估计值逐渐降低。胃旁路手术后食管腺癌的调整风险显著降低（HR=0.3，95%CI，0.1-0.8），而贲门腺癌的调整风险无显著降低（HR=0.9，95%CI，0.5-1.6），当分别分析时。其他减重手术（主要为胃成形术、胃束带术、胃袖状切除术和胆胰分流术）与 ECA 之间无一致关联。
胃旁路手术可能可逆转肥胖个体食管腺癌的发展。
