MORTALITY rates in-hospital, along with the incidence of oesophageal and gastric cancer, have been shown to decrease in patients with severe obesity who underwent bariatric surgery. There is currently a need for, and little information about these incidences in large cohorts. Andrea Lazzati, Intercommunal Hospital Centre of Créteil, France, described the importance of their study in providing this: “Using a national administrative database, we performed a study on a nationwide scale comparing the incidence of oesophageal and gastric cancer between patients with obesity who underwent bariatric surgery and those who did not.”
The current investigation enrolled 303,709 adult patients with severe obesity (80.9% female and a mean age of 40.2 years). These patients were cancer-free for 2 years and underwent bariatric surgery between 2010–2017. In total, 605,140 matched patients (82.8% female and a mean age 40.4 years) who did not undergo surgery were also included as a control. A mean follow-up of 5.62 years in the control group and 6.06 years in the surgery cohort reported 254 and 83 incidences of oesophago-gastric cancer, respectively. Gastric cancer was close to twice as common as oesophageal cancer in both groups. An incidence rate of 6.9 per 100,000 population, per year for the control, and 4.9 per 100,000 population, per year in the surgical group translated to an overall incidence ratio of 1.42 (95% confidence interval [CI]: 1.11–1.82). Multivariable analysis provided evidence of no significant difference in cumulative cancer incidence among patients in the control group versus gastric banding or sleeve gastrectomy surgeries. However, there was a significant decrease in cancer incidence following gastric bypass (hazard ratio [HR]: 0.62; 95% CI: 0.40–0.95). Patients in the surgery group had a lower incidence of oesophago-gastric cancer (HR: 0.76; 95% CI: 0.59–0.98), and lower in-hospital mortality (HR: 0.6; 95% CI: 0.56–0.64).
Lazzati concluded: “The findings suggest that bariatric surgery can be performed as treatment for severe obesity without increasing the risk of oesophageal and gastric cancer.” These results, on a large, nationwide cohort, are expected to greatly impact clinical recommendation, also providing evidence to support patients with obesity making a decision to undergo bariatric surgery.