Division of General Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix.
Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix.
JAMA Surg. 2024 Mar 1;159(3):331-338. doi: 10.1001/jamasurg.2023.5809.
Cancer is one of the leading causes of death in the United States, with the obesity epidemic contributing to its steady increase every year. Recent cohort studies find an association between bariatric surgery and reduced longitudinal cancer risk, but with heterogeneous findings.
This review summarizes how obesity leads to an increased risk of developing cancer and synthesizes current evidence behind the potential for bariatric surgery to reduce longitudinal cancer risk. Overall, bariatric surgery appears to have the strongest and most consistent association with decreased incidence of developing breast, ovarian, and endometrial cancers. The association of bariatric surgery and the development of esophageal, gastric, liver, and pancreas cancer is heterogenous with studies showing either no association or decreased longitudinal incidences. Conversely, there have been preclinical and cohort studies implying an increased risk of developing colon and rectal cancer after bariatric surgery. A review and synthesis of the existing literature reveals epidemiologic shortcomings of cohort studies that potentially explain incongruencies observed between studies.
Studies examining the association of bariatric surgery and longitudinal cancer risk remain heterogeneous and could be explained by certain epidemiologic considerations. This review provides a framework to better define subgroups of patients at higher risk of developing cancer who would potentially benefit more from bariatric surgery, as well as subgroups where more caution should be exercised.
癌症是美国主要死因之一，肥胖症的流行导致其每年稳步增加。最近的队列研究发现，减重手术与降低纵向癌症风险之间存在关联，但研究结果存在差异。
本综述总结了肥胖如何导致癌症风险增加，并综合了目前关于减重手术降低纵向癌症风险的潜在证据。总体而言，减重手术似乎与降低乳腺癌、卵巢癌和子宫内膜癌的发病率具有最强和最一致的关联。减重手术与食管癌、胃癌、肝癌和胰腺癌的发展之间的关联存在异质性，一些研究表明两者之间没有关联，或者纵向发病率降低。相反，有临床前和队列研究表明，减重手术后发生结肠癌和直肠癌的风险增加。对现有文献的回顾和综合揭示了队列研究的流行病学缺陷，这些缺陷可能解释了研究之间观察到的不一致性。
研究减重手术与纵向癌症风险之间的关联仍然存在差异，可能可以用某些流行病学考虑来解释。本综述提供了一个框架，以更好地定义癌症风险较高的患者亚组，这些患者可能从减重手术中获益更多，以及需要更加谨慎的患者亚组。
