Esophagus to Small Intestine

JAMA. 2022;327(24):2423–33

Aminian A, Wilson R, Al-Kurd A, Tu C, Milinovich A, Kroh M, Rosenthal RJ, Brethauer SA, Schauer PR, Kattan MW, Brown JC, Berger NA, Abraham J, Nissen SE

Association of bariatric surgery with cancer risk and mortality in adults with obesity


Importance: Obesity increases the incidence and mortality from some types of cancer, but it remains uncertain whether intentional weight loss can decrease this risk.
Objective: To investigate whether bariatric surgery is associated with lower cancer risk and mortality in patients with obesity.
Design, setting, and participants: In the SPLENDID (Surgical Procedures and Long-term Effectiveness in Neoplastic Disease Incidence and Death) matched cohort study, adult patients with a body mass index (BMI) ≥ 35 who underwent bariatric surgery at a US health system between 2004 and 2017 were included. Patients who underwent bariatric surgery were matched 1:5 to patients who did not undergo surgery for their obesity, resulting in a total of 30,318 patients. Follow-up ended in February 2021.
Exposures: Bariatric surgery (n = 5053), including Roux-en-Y gastric bypass and sleeve gastrectomy, versus non-surgical care (n = 25,265).
Main outcomes and measures: Multivariable Cox regression analysis estimated time to incident obesity-associated cancer (a composite of 13 cancer types as the primary end point) and cancer-related mortality.
Results: The study included 30,318 patients (median age, 46 years; median BMI, 45; 77% female; and 73% White) with a median follow-up of 6.1 years (interquartile range, 3.8–8.9 years). The mean between-group difference in body weight at 10 years was 24.8 kg (95% confidence interval [CI]: 24.6–25.1 kg) or a 19.2% (95% CI: 19.1–19.4%) greater weight loss in the bariatric surgery group. During follow-up, 96 patients in the bariatric surgery group and 780 patients in the non-surgical control group had an incident obesity-associated cancer (incidence rate [IR] of 3.0 events vs. 4.6 events, respectively, per 1000 person-years). The cumulative incidence of the primary end point at 10 years was 2.9% (95% CI: 2.2–3.6%) in the bariatric surgery group and 4.9% (95% CI: 4.5–5.3%) in the non-surgical control group (absolute risk difference, 2.0%, 95% CI: 1.2–2.7%; adjusted hazard ratio [aHR] = 0.68, 95% CI: 0.53–0.87; p = 0.002). Cancer-related mortality occurred in 21 patients in the bariatric surgery group and 205 patients in the non-surgical control group (IR of 0.6 events vs. 1.2 events, respectively, per 1000 person-years). The cumulative incidence of cancer-related mortality at 10 years was 0.8% (95% CI: 0.4–1.2%) in the bariatric surgery group and 1.4% (95% CI: 1.1–1.6%) in the non-surgical control group (absolute risk difference, 0.6%, 95% CI: 0.1–1.0%; aHR = 0.52, 95% CI: 0.31–0.88; p = 0.01).

Conclusions and relevance: Among adults with obesity, bariatric surgery compared with no surgery was associated with a significantly lower incidence of obesity-associated cancer and cancer-related mortality.

S.E. Nissen, M.D., Professor of Medicine, Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA,
E-Mail: nissens@ccf.org

DOI: 10.1001/jama.2022.9009

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