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Obesity Surgery
Published in: Obesity Surgery 4/2020

01-04-2020 | Obesity | Original Contributions

Effects of Bariatric Surgery on Cancer Risk: Evidence from Meta-analysis

Authors: Kui Zhang, Yupeng Luo, Hao Dai, Zhenhua Deng

Published in: Obesity Surgery | Issue 4/2020

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Abstract

Introduction

Weight loss after bariatric surgery yields important health benefits. A multitude of observational studies have investigated the association of bariatric surgery for severe obesity with the risk of cancer. However, the results were debatable. The aim of the present study was to estimate the effect of bariatric surgery on overall cancer risk.

Methods

A systematic literature search was performed to identify studies evaluating the association of bariatric surgery for severe obesity with the risk of cancer. Meta-analysis was performed to calculate combined prevalence.

Results

Twenty-one cohort studies with 304,516 patients with obesity having under gone bariatric surgery and 8,492,408 patients with obesity as controls were included. Meta-analysis found decreased cancer risk to be associated with bariatric surgery (OR = 0.56, 95% CI = 0.48–0.66), both for the incidence of cancer (OR = 0.56, 95% CI = 0.46–0.68) and mortality of cancer (OR = 0.56, 95% CI = 0.41–0.75). In subgroup analysis, bariatric surgery was significantly associated with decreased breast cancer risk and endometrial cancer risk, but not associated with other cancer risk.

Conclusions

Our meta-analysis indicated that bariatric surgery for severe obesity was associated with decreased cancer risk, both for cancer incidence and mortality. Moreover, further studies estimating the functional effect and side effects may eventually provide a better, comprehensive understanding.
Literature
1.
2.
3.
Pischon T, Boeing H, Hoffmann K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med. 2008;359(20):2105–20.CrossRefPubMed
4.
Renehan AG, Tyson M, Egger M, et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371(9612):569–78.CrossRefPubMed
5.
6.
Calle EE, Rodriguez C, Walker-Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348(17):1625–38.CrossRefPubMed
7.
Curioni CC, Lourenco PM. Long-term weight loss after diet and exercise: a systematic review. Int J Obes. 2005;29(10):1168–74.CrossRef
8.
Anderson JW, Konz EC, Frederich RC, et al. Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr. 2001;74(5):579–84.CrossRefPubMed
9.
Papasavas PK, Gagne DJ, Kelly J, et al. Laparoscopic Roux-en-Y gastric bypass is a safe and effective operation for the treatment of morbid obesity in patients older than 55 years. Obes Surg. 2004;14(8):1056–61.CrossRefPubMed
10.
Lynch J, Belgaumkar A. Bariatric surgery is effective and safe in patients over 55: a systematic review and meta-analysis. Obes Surg. 2012;22(9):1507–16.CrossRefPubMed
11.
Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142(4):621–32. discussion 32-5CrossRefPubMed
12.
O’Brien PE, McPhail T, Chaston TB, et al. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16(8):1032–40.CrossRefPubMed
13.
Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56. e5CrossRefPubMed
14.
Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34.CrossRefPubMed
15.
Schauer DP, Feigelson HS, Koebnick C, et al. Bariatric surgery and the risk of cancer in a large multisite cohort. Ann Surg. 2019;269(1):95–101.CrossRefPubMed
16.
Kauppila JH, Tao W, Santoni G, et al. Effects of obesity surgery on overall and disease-specific mortality in a 5-country. Gastroenterology: Population-based Study; 2019 Mar 30.
17.
Hassinger TE, Mehaffey JH, Hawkins RB, et al. Overall and estrogen receptor-positive breast cancer incidences are decreased following bariatric surgery. Obes Surg. 2019;29(3):776–81.CrossRefPubMed
18.
Feigelson HS, Caan B, Weinmann S, Leonard AC, Powers JD, Yenumula PR, et al. Bariatric surgery is associated with reduced risk of breast cancer in both premenopausal and postmenopausal women. Annals of surgery. 2019 Apr 13.
19.
Pontiroli AE, Zakaria AS, Fanchini M, et al. A 23-year study of mortality and development of co-morbidities in patients with obesity undergoing bariatric surgery (laparoscopic gastric banding) in comparison with medical treatment of obesity. Cardiovasc Diabetol. 2018;17(1):161.CrossRefPubMedPubMedCentral
20.
Mackenzie H, Markar SR, Askari A, et al. Obesity surgery and risk of cancer. Br J Surg. 2018;105(12):1650–7.CrossRefPubMed
21.
Ceriani V, Sarro G, Micheletto G, et al. Long-term mortality in obese subjects undergoing malabsorptive surgery (biliopancreatic diversion and biliointestinal bypass) versus medical treatment. Int J Obes. 2018;
22.
Schauer DP, Feigelson HS, Koebnick C, et al. Association between weight loss and the risk of cancer after bariatric surgery. Obesity (Silver Spring). 2017;25(Suppl 2):S52–S7.CrossRef
23.
Maret-Ouda J, Tao W, Mattsson F, et al. Esophageal adenocarcinoma after obesity surgery in a population-based cohort study. Surg Obes Relat Dis. 2017;13(1):28–34.CrossRefPubMed
24.
Gribsholt SB, Thomsen RW, Svensson E, et al. Overall and cause-specific mortality after Roux-en-Y gastric bypass surgery: a nationwide cohort study. Surg Obes Relat Dis. 2017;13(4):581–7.CrossRefPubMed
25.
Anveden A, Taube M, Peltonen M, et al. Long-term incidence of female-specific cancer after bariatric surgery or usual care in the Swedish Obese Subjects Study. Gynecol Oncol. 2017;145(2):224–9.CrossRefPubMedPubMedCentral
26.
Davidson LE, Adams TD, Kim J, et al. Association of patient age at gastric bypass surgery with long-term all-cause and cause-specific mortality. JAMA Surgery. 2016;151(7):631–7.CrossRefPubMedPubMedCentral
27.
Douglas IJ, Bhaskaran K, Batterham RL, et al. Bariatric surgery in the United Kingdom: a cohort study of weight loss and clinical outcomes in routine clinical care. PLoS Med. 2015;12(12):e1001925.CrossRefPubMedPubMedCentral
28.
Ward KK, Roncancio AM, Shah NR, et al. Bariatric surgery decreases the risk of uterine malignancy. Gynecol Oncol. 2014;133(1):63–6.CrossRefPubMed
29.
Buchwald H, Rudser KD, Williams SE, et al. Overall mortality, incremental life expectancy, and cause of death at 25 years in the program on the surgical control of the hyperlipidemias. Ann Surg. 2010;251(6):1034–40.CrossRefPubMed
30.
Adams TD, Stroup AM, Gress RE, et al. Cancer incidence and mortality after gastric bypass surgery. Obesity (Silver Spring). 2009;17(4):796–802.CrossRef
31.
Christou NV, Lieberman M, Sampalis F, et al. Bariatric surgery reduces cancer risk in morbidly obese patients. Surg Obes Relat Dis. 2008;4(6):691–5.CrossRefPubMed
32.
Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.CrossRefPubMed
33.
Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.CrossRefPubMed
34.
Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240(3):416–23.CrossRefPubMedPubMedCentral
35.
Liakopoulos V, Franzen S, Svensson AM, et al. Pros and cons of gastric bypass surgery in individuals with obesity and type 2 diabetes: nationwide, matched, observational cohort study. BMJ Open. 2019;9(1):e023882.CrossRefPubMedPubMedCentral
36.
37.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.CrossRefPubMed
38.
Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22(4):719–48.PubMed
39.
40.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101.CrossRefPubMed
41.
Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organization technical report series. 2000;894:i-xii, 1–253. Epub 2001/03/10. eng.
42.
Very low-calorie diets. National Task Force on the prevention and treatment of obesity, National Institutes of Health. Jama. 1993;270(8):967–74.CrossRef
43.
Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1–190. 215-357, iii-ivCrossRefPubMed
44.
Keating CL, Dixon JB, Moodie ML, et al. Cost-effectiveness of surgically induced weight loss for the management of type 2 diabetes: modeled lifetime analysis. Diabetes Care. 2009;32(4):567–74.CrossRefPubMedPubMedCentral
45.
Raaijmakers LC, Pouwels S, Thomassen SE, et al. Quality of life and bariatric surgery: a systematic review of short- and long-term results and comparison with community norms. Eur J Clin Nutr. 2017;71(4):441–9.CrossRefPubMed
46.
Heneghan HM, Meron-Eldar S, Brethauer SA, et al. Effect of bariatric surgery on cardiovascular risk profile. Am J Cardiol. 2011;108(10):1499–507.CrossRefPubMed
47.
Romeo S, Maglio C, Burza MA, et al. Cardiovascular events after bariatric surgery in obese subjects with type 2 diabetes. Diabetes Care. 2012;35(12):2613–7.CrossRefPubMedPubMedCentral
48.
Johnson BL, Blackhurst DW, Latham BB, et al. Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes mellitus. J Am Coll Surg. 2013;216(4):545–56. discussion 56-8CrossRefPubMed
49.
Busetto L, De Stefano F, Pigozzo S, et al. Long-term cardiovascular risk and coronary events in morbidly obese patients treated with laparoscopic gastric banding. Surg Obes Relat Dis. 2014;10(1):112–20.CrossRefPubMed
50.
Eheman C, Henley SJ, Ballard-Barbash R, et al. Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer. 2012;118(9):2338–66.CrossRefPubMed
51.
52.
Wiggins T, Antonowicz SS, Markar SR. Cancer risk following bariatric surgery-systematic review and meta-analysis of national population-based cohort studies. Obes Surg. 2019;29(3):1031–9.CrossRefPubMed
53.
Yang XW, Li PZ, Zhu LY, et al. Effects of bariatric surgery on incidence of obesity-related cancers: a meta-analysis. Medical Science Monitor : international medical journal of experimental and clinical research. 2015;21:1350–7.CrossRef
54.
Roberts DL, Dive C, Renehan AG. Biological mechanisms linking obesity and cancer risk: new perspectives. Annu Rev Med. 2010;61:301–16.CrossRefPubMed
55.
Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer. 2004;4(8):579–91.CrossRefPubMed
56.
Key TJ, Appleby PN, Reeves GK, et al. Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women. J Natl Cancer Inst. 2003;95(16):1218–26.CrossRefPubMed
57.
Kaaks R, Lukanova A, Kurzer MS. Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2002;11(12):1531–43.
58.
de Waard F, Poortman J, de Pedro-Alvarez FM, et al. Weight reduction and oestrogen excretion in obese post-menopausal women. Maturitas. 1982;4(2):155–62. Epub 1982/08/01. engCrossRefPubMed
59.
Bilhorn KR, Luo Y, Lee BT, et al. High-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and cardiovascular disease in United States adults. Am J Cardiol. 2012;110(10):1464–7.CrossRefPubMed
60.
Ashrafian H, Ahmed K, Rowland SP, et al. Metabolic surgery and cancer: protective effects of bariatric procedures. Cancer. 2011;117(9):1788–99.CrossRefPubMed
Metadata
Title
Effects of Bariatric Surgery on Cancer Risk: Evidence from Meta-analysis
Authors
Kui Zhang
Yupeng Luo
Hao Dai
Zhenhua Deng
Publication date
01-04-2020
Publisher
Springer US
Published in
Obesity Surgery / Issue 4/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-019-04368-4

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