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Colorectal Cancer Risk Is Impacted by Sex and Type of Surgery After Bariatric Surgery

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Abstract

Purpose

Sex differences exist in the associations between obesity and the risk of colorectal cancer (CRC). However, limited data exist on how sex affects CRC risk after bariatric surgery.

Materials and Methods

This retrospective cohort study used the 2012–2020 MarketScan database. We employed a propensity-score-matched analysis and precise coding to define CRC in this nationwide US study. Adjusted hazards ratio (HR) assessed CRC risk ≥ 6 months. In a restricted analysis, logistic regression with adjusted odds ratios (OR) examined CRC risk ≥ 3 years.

Results

Our sample included 327,734 controls with severe obesity and 88,630 patients with Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (VSG). The odds of cessation of diabetes mellitus medications, a surrogate for diabetes remission, were higher post-surgery vs. controls, especially in RYGB and males. In females, CRC risk decreased post-RYGB compared to controls (HR = 0.40, 95%CI: 0.18–0.87, p = 0.02). However, VSG was not associated with lower CRC risk in females. Paradoxically, in males compared to controls, CRC risk trended toward an almost significant increase, especially after 3 years or more from surgery (OR = 2.18, 95%CI: 0.97–4.89, p = 0.06). Males had a higher risk of CRC, particularly rectosigmoid cancer, than females after bariatric surgery (HR = 2.69, 95% CI: 1.35–5.38, p < 0.001). Furthermore, diabetes remission was not associated with a lower CRC risk post-surgery.

Conclusion

Our data suggest an increased risk of CRC in males compared to females after bariatric surgery. Compared to controls, there was a decrease in CRC risk in females’ post-RYGB but not VSG. Mechanistic studies are needed to explain these differences.

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Abbreviations

AIDS:

Acquired immunodeficiency syndromes

BRS:

Bariatric surgery

BMI:

Body mass index

CCI:

Charlson comorbidity index

CI:

Confidence interval

CPT:

Current procedural terminology

CRC:

Colorectal cancer

HEI:

Healthy eating index

HIV:

Human immunodeficiency virus

HR:

Hazards ratio

K.M.:

Kaplan Meier

OR:

Odds ratio

RYGB:

Roux-En-Y gastric bypass

SCFA:

Short-chain fatty acid

VSG:

Vertical sleeve gastrectomy

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Funding

The MarketScan database analysis was supported by an award (UL1TR002733) from the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The Ohio State University, 395 W. 12th Avenue, 2nd floor, Columbus, OH, 43210, USA

    Hisham Hussan & Samuel Akinyeye

  2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, UC Davis Medical Center, Sacramento, CA, USA

    Hisham Hussan

  3. Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA

    Maria Mihaylova & Steven K. Clinton

  4. Department of Biological Chemistry and Pharmacology, College of Medicine, The Ohio State University, Columbus, OH, USA

    Maria Mihaylova

  5. Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA

    Eric McLaughlin & ChienWei Chiang

  6. Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA

    Steven K. Clinton

  7. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Oregon Health & Science University, Portland, OR, USA

    David Lieberman

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  1. Hisham Hussan
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  2. Samuel Akinyeye
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  3. Maria Mihaylova
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  4. Eric McLaughlin
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Contributions

Hisham Hussan was involved in the conception, design, funding acquisition, and interpretation of data as well as in the drafting and critical revision of the manuscript. Samuel Akinyeye was involved in the study design and drafting of the manuscript. Chienwei Chiang was involved in acquiring the data and the study design. Eric McLaughlin was involved in the study methodology, statistical analysis of the data, and drafting of the manuscript. The above authors had full access to all the data in the study and take responsibility for the integrity and accuracy of the data and analyses. David Lieberman was involved in the study design, methodology, and critical revision of the manuscript. Maria Mihaylova was involved in funding acquisition and critical suggestions and revision of the manuscript. Steven K. Clinton was involved in critical revision of the manuscript.

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Correspondence to Hisham Hussan.

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Key Points

In females, the risk of colorectal cancer is reduced after gastric bypass but not conclusively after vertical sleeve gastrectomy.

Males had no reduction in the risk of colorectal cancer, despite a better improvement in diabetes than women after bariatric surgery.

Males had a higher risk of colorectal cancer, particularly rectosigmoid cancer, than females after bariatric surgery.

Amelioration of type 2 diabetes was not associated with a lower risk of colorectal cancer after surgery.

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Hussan, H., Akinyeye, S., Mihaylova, M. et al. Colorectal Cancer Risk Is Impacted by Sex and Type of Surgery After Bariatric Surgery. OBES SURG 32, 2880–2890 (2022). https://doi.org/10.1007/s11695-022-06155-0

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