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Meta-Analysis
. 2023 Mar 24;24(7):6192.
doi: 10.3390/ijms24076192.

Systematic Review and Meta-Analysis of the Impact of Bariatric Surgery on Future Cancer Risk

Robert B Wilson  1 , Dhruvi Lathigara  2 , Devesh Kaushal  2
Affiliations
Meta-Analysis

Systematic Review and Meta-Analysis of the Impact of Bariatric Surgery on Future Cancer Risk

Robert B Wilson et al. Int J Mol Sci. .

Abstract

The study aimed to perform a systematic review and meta-analysis of the evidence for the prevention of future cancers following bariatric surgery. A systematic literature search of the Cochrane Library, Embase, Scopus, Web of Science and PubMed databases (2007-2023), Google Scholar and grey literature was conducted. A meta-analysis was performed using the inverse variance method and random effects model. Thirty-two studies involving patients with obesity who received bariatric surgery and control patients who were managed with conventional treatment were included. The meta-analysis suggested bariatric surgery was associated with a reduced overall incidence of cancer (RR 0.62, 95% CI 0.46-0.84, p < 0.002), obesity-related cancer (RR 0.59, 95% CI 0.39-0.90, p = 0.01) and cancer-associated mortality (RR 0.51, 95% CI 0.42-0.62, p < 0.00001). In specific cancers, bariatric surgery was associated with reduction in the future incidence of hepatocellular carcinoma (RR 0.35, 95% CI 0.22-0.55, p < 0.00001), colorectal cancer (RR 0.63, CI 0.50-0.81, p = 0.0002), pancreatic cancer (RR 0.52, 95% CI 0.29-0.93, p = 0.03) and gallbladder cancer (RR 0.41, 95% CI 0.18-0.96, p = 0.04), as well as female specific cancers, including breast cancer (RR 0.56, 95% CI 0.44-0.71, p < 0.00001), endometrial cancer (RR 0.38, 95% CI 0.26-0.55, p < 0.00001) and ovarian cancer (RR 0.45, 95% CI 0.31-0.64, p < 0.0001). There was no significant reduction in the incidence of oesophageal, gastric, thyroid, kidney, prostate cancer or multiple myeloma after bariatric surgery as compared to patients with morbid obesity who did not have bariatric surgery. Obesity-associated carcinogenesis is closely related to metabolic syndrome; visceral adipose dysfunction; aromatase activity and detrimental cytokine, adipokine and exosomal miRNA release. Bariatric surgery results in long-term weight loss in morbidly obese patients and improves metabolic syndrome. Bariatric surgery may decrease future overall cancer incidence and mortality, including the incidence of seven obesity-related cancers.

Keywords: GLP-1; NASH; adipokine; bariatric surgery; cancer; carcinogen; cytokine; diabetes; exosome; gastric bypass surgery; leptin; meta-analysis; metabolic surgery; metabolic syndrome; obesity; oestrogen; semaglutide; sleeve gastrectomy; weight loss.

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Conflict of interest statement

R.B.W. discloses relationships with Merck, Fisher and Paykel, Medtronic, and Ethicon involving funding for education, research, and attendance at scientific meetings. The analyses, conclusions, opinions, and statements expressed in the study are solely those of the authors. No external funding was received by any of the authors for the preparation or publication of this study. No endorsement is intended or should be inferred.

Figures

Figure A1
Figure A1
Overall cancer incidence RE model funnel plot.
Figure A2
Figure A2
Incidence of obesity-associated cancers (OAC) RE model funnel plot.
Figure A3
Figure A3
Cancer-related mortality RE funnel plot.
Figure A4
Figure A4
Overall breast cancer random effects model funnel plot.
Figure A5
Figure A5
Premenopausal breast cancer random effects model funnel plot.
Figure A6
Figure A6
Postmenopausal breast cancer random effects model funnel plot.
Figure A7
Figure A7
Endometrial cancer random effects model.
Figure A8
Figure A8
Ovarian cancer random effects model funnel plot.
Figure A9
Figure A9
Colorectal cancer random effects model funnel plot.
Figure A10
Figure A10
CRC male random effects model funnel plot.
Figure A11
Figure A11
CRC female random effects model funnel plot.
Figure A12
Figure A12
Oesophageal random effects model funnel plot.
Figure A13
Figure A13
HCC RE model funnel plot.
Figure A14
Figure A14
Kidney cancer random effects model funnel plot.
Figure A15
Figure A15
Gallbladder cancer random effects model funnel plot.
Figure A16
Figure A16
Pancreatic cancer random effects model funnel plot.
Figure A17
Figure A17
Multiple myeloma random effects model funnel plot.
Figure A18
Figure A18
Thyroid cancer random effects model funnel plot.
Figure A19
Figure A19
Gastric cancer random effects model funnel plot.
Figure A20
Figure A20
Prostate cancer random effects model funnel plot.
Figure A21
Figure A21
Future CRC risk incidence. Forest plot with Mackenzie et al. [45] data removed from the overall and subgroup CRC analysis after the sensitivity analysis [38,40,42,43,49,50,58,59,60,61,62,63].
Figure 1
Figure 1
PRISMA flow chart [34,35].
Figure 2
Figure 2
Risk of bias assessment in 32 studies based on 7 domains [38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69].
Figure 3
Figure 3
Overall cancer incidence RE analysis [38,39,40,41,42,43,44,46,47,48,49,50,66].
Figure 4
Figure 4
Incidence of obesity-associated cancers (OAC) [38,39,40,42,43,49,66].
Figure 5
Figure 5
Cancer-related mortality [38,48,49,51,52].
Figure 6
Figure 6
Breast cancer incidence [38,39,40,43,45,49,50,53,54,55,56,57,62].
Figure 7
Figure 7
Endometrial cancer incidence [38,39,43,45,49,50,53,55].
Figure 8
Figure 8
Ovarian cancer incidence [38,39,40,49,53,55].
Figure 9
Figure 9
Colorectal cancer incidence [38,40,42,43,45,49,50,58,59,60,61,62,63].
Figure 10
Figure 10
Oesophageal adenocarcinoma incidence [38,39,40,42,43,45,49,64,65].
Figure 11
Figure 11
Hepatocellular carcinoma incidence [38,39,40,42,43,49,67,68].
Figure 12
Figure 12
Kidney cancer incidence [38,39,40,42,43,49,50,62,69].
Figure 13
Figure 13
Pancreatic cancer incidence [38,39,40,42,43,49,50].
Figure 14
Figure 14
Gallbladder cancer incidence [38,39,40,42,43,49].
Figure 15
Figure 15
Multiple myeloma incidence [38,39,40,42,43,49,50].
Figure 16
Figure 16
Thyroid cancer incidence [38,39,40,42,43,49].
Figure 17
Figure 17
Gastric cancer incidence [38,39,40,42,49].
Figure 18
Figure 18
Prostate cancer incidence [38,39,40,49].
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