Risk assessment for esophageal cancer after bariatric surgery: a comparative cohort study between sleeve gastrectomy and gastric bypass.

BACKGROUND

The risk of esophageal cancer after bariatric surgery is a matter of debate.

OBJECTIVE

This study aims to evaluate the risk of esophageal cancer following sleeve gastrectomy (SG) and gastric bypass (GB).

METHODS

We extracted data from the national discharge database (Programme De Médicalisation des Systèmes d'Information) for patients who underwent bariatric surgery in France between 2007 and 2020. Adult patients undergoing SG or GB were included and followed until December 2022. The primary endpoints were the occurrence of esophageal and gastroesophageal junction (GEJ) cancers. The impact of bariatric procedures on cancer development was assessed using multivariate analysis, along with several sensitivity analyses to validate the findings.

RESULTS

Among the 370,271 patients included, 68.4% underwent SG and 31.6% underwent GB. The median follow-up duration was 7.4 years (interquartile range: 5.3-9.6 years), with approximately 81,000 patients followed for at least 10 years. A total of 96 cases of esophageal cancer were identified: 25 in the GB group and 71 in the SG group. The incidence rates were 2.6 per 100,000 person-years for GB and 3.9 for SG, resulting in an incidence rate ratio of .64 (95% confidence interval [CI]: .40-1.01, P = .055). In multivariate analysis, no significant difference in cancer incidence was found between SG and GB (hazard ratio [HR]: 1.60, 95% CI: .90-2.5, P = .06). Sensitivity analyses further confirmed these findings, showing similar nonsignificant differences across various models.

CONCLUSION

In this extensive national cohort of bariatric surgery patients, no significant differences were observed in the incidence of esophageal and GEJ cancer between SG and GB.