Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 12/2013

01-12-2013 | Review

Effect of bariatric surgery on oncologic outcomes: a systematic review and meta-analysis

Authors: May C. Tee, Yin Cao, Garth L. Warnock, Frank B. Hu, Jorge E. Chavarro

Published in: Surgical Endoscopy | Issue 12/2013

Login to get access

Abstract

Background

Obesity is a major public health issue and is associated with increased risk of several cancers, currently a leading cause of mortality. Obese patients undergoing bariatric surgery may allow for evaluation of the effect of intentional excess weight loss on subsequent risk of cancer. We aimed to evaluate cancer risk, incidence, and mortality after bariatric surgery.

Methods

A comprehensive literature search was conducted using PubMed/MEDLINE and Embase with literature published from the inception of both databases to January 2012. Inclusion criteria incorporated all human studies examining oncologic outcomes after bariatric surgery. Two authors independently reviewed selected studies and relevant articles from their bibliographies for data extraction, quality appraisal, and meta-analysis.

Results

Six observational studies (n = 51,740) comparing relative risk (RR) of cancer in obese patients undergoing bariatric surgery versus obese control subjects were analyzed. Overall, the RR of cancer in obese patients after undergoing bariatric surgery was 0.55 [95 % confidence interval (CI) 0.41–0.73, p < 0.0001, I 2 = 83 %]. The effect of bariatric surgery on cancer risk was modified by gender (p = 0.021). The pooled RR in women was 0.68 (95 % CI 0.60–0.77, p < 0.0001, I 2 < 0.1 %) and in men was 0.99 (95 % CI 0.74–1.32, p = 0.937, I 2 < 0.1 %).

Conclusions

Bariatric surgery reduces cancer risk and mortality in formerly obese patients. When stratifying the meta-analysis by gender, the effect of bariatric surgery on oncologic outcomes is protective in women but not in men.
Literature
1.
Anderson AS, Caswell S (2009) Obesity management—an opportunity for cancer prevention. Surgeon 7(5):282–285PubMedCrossRef
2.
3.
Pender JR, Pories WJ (2005) Epidemiology of obesity in the United States. Gastroenterol Clin North Am 34(1):1–7PubMedCrossRef
4.
Bianchini F, Kaaks R, Vainio H (2002) Overweight, obesity, and cancer risk. Lancet Oncol 3(9):565–574PubMedCrossRef
5.
Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 348(17):1625–1638PubMedCrossRef
6.
7.
McTiernan A (2005) Obesity and cancer: the risks, science, and potential management strategies. Oncology (Williston Park) 19(7):871–881
8.
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1737PubMedCrossRef
9.
Christou NV (2009) Impact of obesity and bariatric surgery on survival. World J Surg 33(10):2022–2027PubMedCrossRef
10.
Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, Thomas S, Abood B, Nissen SE, Bhatt DL (2012) Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 366(17):1567–1576PubMedCrossRef
11.
Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, Dahlgren S, Larsson B, Narbro K, Sjöström CD, Sullivan M, Wedel H, Swedish Obese Subjects Study Scientific Group (2004) Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 351(26):2683–2689PubMedCrossRef
12.
Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C, Carlsson B, Bengtsson C, Dahlgren S, Gummesson A, Jacobson P, Karlsson J, Lindroos AK, Lönroth H, Näslund I, Olbers T, Stenlöf K, Torgerson J, Agren G, Carlsson LM, Swedish Obese Subjects Study (2007) Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 357(8):741–752PubMedCrossRef
13.
Blackburn GL, Hutter MM, Harvey AM, Apovian CM, Boulton HR, Cummings S, Fallon JA, Greenberg I, Jiser ME, Jones DB, Jones SB, Kaplan LM, Kelly JJ, Kruger RS Jr, Lautz DB, Lenders CM, Lonigro R, Luce H, McNamara A, Mulligan AT, Paasche-Orlow MK, Perna FM, Pratt JS, Riley SM Jr, Robinson MK, Romanelli JR, Saltzman E, Schumann R, Shikora SA, Snow RL, Sogg S, Sullivan MA, Tarnoff M, Thompson CC, Wee CC, Ridley N, Auerbach J, Hu FB, Kirle L, Buckley RB, Annas CL (2009) Expert panel on weight loss surgery: executive report update. Obesity (Silver Spring) 17(5):842–846CrossRef
14.
Adams TD, Hunt SC (2009) Cancer and obesity: effect of bariatric surgery. World J Surg 33(10):2028–2033PubMedCrossRef
15.
Adams TD, Stroup AM, Gress RE, Adams KF, Calle EE, Smith SC, Halverson RC, Simper SC, Hopkins PN, Hunt SC (2009) Cancer incidence and mortality after gastric bypass surgery. Obesity (Silver Spring) 17(4):796–7802CrossRef
16.
Christou NV, Lieberman M, Sampalis F, Sampalis JS (2008) Bariatric surgery reduces cancer risk in morbidly obese patients. Surg Obes Relat Dis 4(6):691–695PubMedCrossRef
17.
Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean AP, MacLean LD (2004) Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 240(3):416–423PubMedCrossRef
18.
McCawley GM, Ferriss JS, Geffel D, Northup CJ, Modesitt SC (2009) Cancer in obese women: potential protective impact of bariatric surgery. J Am Coll Surg 208(6):1093–1098PubMedCrossRef
19.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–2012PubMedCrossRef
20.
21.
Egger M, Davey Smith G, Altman DG (eds) (2001) Systematic reviews in health care: meta-analysis in context, 2nd edn. BMJ Books, London
22.
Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, Lamonte MJ, Stroup AM, Hunt SC (2007) Long-term mortality after gastric bypass surgery. N Engl J Med 357(8):753–761PubMedCrossRef
23.
Sjöström L, Gummesson A, Sjöström CD, Narbro K, Peltonen M, Wedel H, Bengtsson C, Bouchard C, Carlsson B, Dahlgren S, Jacobson P, Karason K, Karlsson J, Larsson B, Lindroos AK, Lönroth H, Näslund I, Olbers T, Stenlöf K, Torgerson J, Carlsson LM, Swedish Obese Subjects Study (2009) Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol 10(7):653–662PubMedCrossRef
24.
Simera I, Moher D, Hirst A, Hoey J, Schulz KF, Altman DG (2010) Transparent and accurate reporting increases reliability, utility, and impact of your research: reporting guidelines and the EQUATOR network. BMC Med 8:24PubMedCrossRef
25.
Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101PubMedCrossRef
26.
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634PubMedCrossRef
27.
Boru C, Silecchia G, Pecchia A, Iacobellis G, Greco F, Rizzello M, Basso N (2005) Prevalence of cancer in Italian obese patients referred for bariatric surgery. Obes Surg 15(8):1171–1176PubMedCrossRef
28.
Gagne DJ, Papasavas PK, Maalouf M, Urbandt JE, Caushaj PF (2009) Obesity surgery and malignancy: our experience after 1500 cases. Surg Obes Relat Dis 5(2):160–164PubMedCrossRef
29.
Ostlund MP, Lu Y, Lagergren J (2010) Risk of obesity-related cancer after obesity surgery in a population-based cohort study. Ann Surg 252(6):972–976PubMedCrossRef
30.
Sjöström L (2008) Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes (Lond) 32(suppl 7):S93–S97CrossRef
31.
O’Brien PE, Dixon JB, Laurie C, Skinner S, Proietto J, McNeil J, Strauss B, Marks S, Schachter L, Chapman L, Anderson M (2006) Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med 144(9):625–633PubMedCrossRef
32.
Imayama I, Ulrich CM, Alfano CM, Wang C, Xiao L, Wener MH, Campbell KL, Duggan C, Foster-Schubert KE, Kong A, Mason CE, Wang CY, Blackburn GL, Bain CE, Thompson HJ, McTiernan A (2012) Effects of a caloric restriction weight loss diet and exercise on inflammatory biomarkers in overweight/obese postmenopausal women: a randomized controlled trial. Cancer Res 72(9):2314–2326PubMedCrossRef
33.
Cummings DE, Weigle DS, Frayo RS, Breen PA, Ma MK, Dellinger EP, Purnell JQ (2002) Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery. N Engl J Med 346(21):1623–1630PubMedCrossRef
34.
Cummings DE, Overduin J, Foster-Schubert KE (2004) Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution. J Clin Endocrinol Metab 89(6):2608–2615PubMedCrossRef
35.
Hickey MS, Pories WJ, MacDonald KG Jr, Cory KA, Dohm GL, Swanson MS, Israel RG, Barakat HA, Considine RV, Caro JF, Houmard JA (1998) A new paradigm for type 2 diabetes mellitus: could it be a disease of the foregut? Ann Surg 227(5):637–643PubMedCrossRef
36.
37.
38.
Cottam D, Fisher B, Ziemba A, Atkinson J, Grace B, Ward DC, Pizzorno G (2010) Tumor growth factor expression in obesity and changes in expression with weight loss: another cause of increased virulence and incidence of cancer in obesity. Surg Obes Relat Dis 6(5):538–5341PubMedCrossRef
39.
Metadata
Title
Effect of bariatric surgery on oncologic outcomes: a systematic review and meta-analysis
Authors
May C. Tee
Yin Cao
Garth L. Warnock
Frank B. Hu
Jorge E. Chavarro
Publication date
01-12-2013
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 12/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-013-3127-9

Other articles of this Issue 12/2013

Surgical Endoscopy 12/2013 Go to the issue

OriginalPaper

Cost analysis of open and laparoscopic pancreaticoduodenectomy: a single institution comparison

OriginalPaper

Laparoendoscopic single-site versus conventional laparoscopic total extraperitoneal hernia repair: a prospective randomized clinical trial

OriginalPaper

Volume and outcome relationship in bariatric surgery in the laparoscopic era

OriginalPaper

Gravity line strategy may reduce risks of intraoperative injury during laparoscopic surgery

Technique

Totally laparoscopic anterior resection with transvaginal assistance and transvaginal specimen extraction: a technique for natural orifice surgery combined with reduced-port surgery

News

SAGES video classics