Obesity Surgery

, Volume 24, Issue 9, pp 1499–1509 | Cite as

Incidence of Cancer Following Bariatric Surgery: Systematic Review and Meta-analysis

  • Daniela Schaan Casagrande
  • Daniela Dornelles Rosa
  • Daniel Umpierre
  • Roberta Aguiar Sarmento
  • Clarissa Garcia Rodrigues
  • Beatriz D. Schaan
Review Article

Abstract

Obesity is linked to the development of cancer. Previous studies have suggested that there is a relationship between bariatric surgery and reduced cancer risk. Data sources were from Medline, Embase, and Cochrane Library. From 951 references, 13 studies met the inclusion criteria (54,257 participants). In controlled studies, bariatric surgery was associated with a reduction in the risk of cancer. The cancer incidence density rate was 1.06 cases per 1000 person-years within the surgery groups. In the meta-regression, we found an inverse relationship between the presurgical body mass index and cancer incidence after surgery (beta coefficient −0.2, P < 0.05). Bariatric surgery is associated with reduced cancer risk in morbidly obese people. However, considering the heterogeneity among the studies, conclusions should be drawn with care.

Keywords

Cancer Morbid obesity Bariatric surgery Gastric bypass 

Supplementary material

11695_2014_1276_MOESM1_ESM.docx (13 kb)
ESM 1(DOCX 12 kb)

References

  1. 1.
    Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999-2008. JAMA : J Am Med Assoc. 2010;303(3):235–41. Epub 2010/01/15.CrossRefGoogle Scholar
  2. 2.
    Rokholm B, Baker JL, Sorensen TI. The levelling off of the obesity epidemic since the year 1999—a review of evidence and perspectives. Obes Rev: Off J Int Assoc Study Obes. 2010;11(12):835–46. Epub 2010/10/27.CrossRefGoogle Scholar
  3. 3.
    May AL, Freedman D, Sherry B, Blanck HM. Obesity—United States, 1999-2010. Morbidity and mortality weekly report Surveillance summaries (Washington, DC : 2002). 2013;62 Suppl 3:120-8. Epub 2013/11/23.Google Scholar
  4. 4.
    Samanic C, Chow WH, Gridley G, et al. Relation of body mass index to cancer risk in 362,552 Swedish men. Cancer Causes Control. 2006;17(7):901–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Parekh N, Chandran U, Bandera EV. Obesity in cancer survival. Annu Rev Nutr. 2012;32:311–42. Epub 2012/05/01.PubMedCrossRefGoogle Scholar
  6. 6.
    Kaidar-Person O, Bar-Sela G, Person B. The two major epidemics of the twenty-first century: obesity and cancer. Obes Surg. 2011;21(11):1792–7. Epub 2011/08/16.PubMedCrossRefGoogle Scholar
  7. 7.
    Calle EE, Kaaks R. Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer. 2004;4(8):579–91.PubMedCrossRefGoogle Scholar
  8. 8.
    Eckel RH. Clinical practice. Nonsurgical management of obesity in adults. N Engl J Med. 2008;358(18):1941–50.PubMedCrossRefGoogle Scholar
  9. 9.
    Colquitt JL, Picot J, Loveman E, et al. Surgery for obesity. Cochrane Database Syst Rev. 2009;2, CD003641.PubMedGoogle Scholar
  10. 10.
    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. discussion 23–4; Epub 2004/08/21.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Sjostrom L. Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes (Lond) (2005). 2008;32 Suppl 7:S93–7.Google Scholar
  12. 12.
    McCawley GM, Ferriss JS, Geffel D, et al. Cancer in obese women: potential protective impact of bariatric surgery. J Am Coll Surg. 2009;208(6):1093–8. Epub 2009/05/30.PubMedCrossRefGoogle Scholar
  13. 13.
    Sjostrom L, Gummesson A, Sjostrom CD, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol. 2009;10(7):653–62. Epub 2009/06/27.PubMedCrossRefGoogle Scholar
  14. 14.
    Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61. Epub 2007/08/24.PubMedCrossRefGoogle Scholar
  15. 15.
    Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA : J Am Med Assoc. 2000;283(15):2008–12.CrossRefGoogle Scholar
  16. 16.
    Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. Available from URL: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp[cited 2013 Feb 05] [updated 02/05/2013; cited 2013 Feb 05, 2013]; Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
  17. 17.
    Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.PubMedCrossRefGoogle Scholar
  18. 18.
    Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. Epub 2003/09/06.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Adams TD, Stroup AM, Gress RE, et al. Cancer incidence and mortality after gastric bypass surgery. Obesity. 2009;17(4):796–802.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Christou NV, Lieberman M, Sampalis F, et al. Bariatric surgery reduces cancer risk in morbidly obese patients. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2008;4(6):691–5. Epub 2008/11/26.CrossRefGoogle Scholar
  21. 21.
    Clough A, Layani L, Shah A, et al. Laparoscopic gastric banding in over 60s. Obes Surg. 2011;21(1):10–7. Epub 2010/05/22.PubMedCrossRefGoogle Scholar
  22. 22.
    Forsell P, Hellers G. The Swedish Adjustable Gastric Banding (SAGB) for morbid obesity: 9 year experience and a 4-year follow-up of patients operated with a new adjustable band. Obes Surg. 1997;7(4):345–51. Epub 1997/08/01.PubMedCrossRefGoogle Scholar
  23. 23.
    Gagne DJ, Papasavas PK, Maalouf M, et al. Obesity surgery and malignancy: our experience after 1500 cases. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2009;5(2):160–4. Epub 2008/10/14.CrossRefGoogle Scholar
  24. 24.
    Gusenoff JA, Koltz PF, O'Malley WJ, et al. Breast cancer and bariatric surgery: temporal relationships of diagnosis, treatment, and reconstruction. Plast Reconstr Surg. 2009;124(4):1025–32. Epub 2009/11/26.PubMedCrossRefGoogle Scholar
  25. 25.
    Marsk R, Freedman J, Tynelius P, et al. Antiobesity surgery in Sweden from 1980 to 2005: a population-based study with a focus on mortality. Ann Surg. 2008;248(5):777–81. Epub 2008/10/25.PubMedCrossRefGoogle Scholar
  26. 26.
    Ostlund MP, Lu Y, Lagergren J. Risk of obesity-related cancer after obesity surgery in a population-based cohort study. Ann Surg. 2010;252(6):972–6. Epub 2010/06/24.PubMedCrossRefGoogle Scholar
  27. 27.
    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. Epub 2007/08/24.PubMedCrossRefGoogle Scholar
  28. 28.
    Srikanth MS, Fox SR, Oh KH, et al. Renal cell carcinoma following bariatric surgery. Obes Surg. 2005;15(8):1165–70. Epub 2005/10/04.PubMedCrossRefGoogle Scholar
  29. 29.
    Steffen R, Potoczna N, Bieri N, et al. Successful multi-intervention treatment of severe obesity: a 7-year prospective study with 96 % follow-up. Obes Surg. 2009;19(1):3–12. Epub 2008/09/17.PubMedCrossRefGoogle Scholar
  30. 30.
    Sugerman HJ, Sugerman EL, Wolfe L, et al. Risks and benefits of gastric bypass in morbidly obese patients with severe venous stasis disease. Ann Surg. 2001;234(1):41–6. Epub 2001/07/20.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Sultan S, Gupta D, Parikh M, et al. Five-year outcomes of patients with type 2 diabetes who underwent laparoscopic adjustable gastric banding. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. 2010;6(4):373–6. Epub 2010/07/16.CrossRefGoogle Scholar
  32. 32.
    Neovius M, Narbro K, Keating C, et al. Health care use during 20 years following bariatric surgery. JAMA : J Am Med Assoc. 2012;308(11):1132–41. Epub 2012/09/20.CrossRefGoogle Scholar
  33. 33.
    Derogar M, Hull MA, Kant P, et al. Increased risk of colorectal cancer after obesity surgery. Ann Surg. 2013;258(6):983–8. Epub 2013/03/09.PubMedCrossRefGoogle Scholar
  34. 34.
    Burza MA, Pirazzi C, Maglio C, et al. PNPLA3 I148M (rs738409) genetic variant is associated with hepatocellular carcinoma in obese individuals. Dig liver Dis : Off J Ital Soc Gastroenterol Ital Assoc Study Liver. 2012;44(12):1037–41. Epub 2012/06/19.CrossRefGoogle Scholar
  35. 35.
    Maglio C, Ericson U, Burza MA, et al. The IRS1 rs2943641 variant and risk of future cancer among morbidly obese individuals. J Clin Endocrinol Metab. 2013;98(4):E785–9. Epub 2013/02/19.PubMedCrossRefGoogle Scholar
  36. 36.
    Rapp K, Schroeder J, Klenk J, et al. Obesity and incidence of cancer: a large cohort study of over 145,000 adults in Austria. Br J Cancer. 2005;93(9):1062–7. Epub 2005/10/20.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Lukanova A, Bjor O, Kaaks R, et al. Body mass index and cancer: results from the Northern Sweden Health and Disease Cohort. Int J Cancer J int Cancer. 2006;118(2):458–66. Epub 2005/07/29.CrossRefGoogle Scholar
  38. 38.
    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. Epub 2008/02/19.PubMedCrossRefGoogle Scholar
  39. 39.
    Birks S, Peeters A, Backholer K, et al. A systematic review of the impact of weight loss on cancer incidence and mortality. Obes Rev: Off J Int Assoc Study Obes. 2012;13(10):868–91. Epub 2012/06/08.CrossRefGoogle Scholar
  40. 40.
    Topol EJ, Bousser MG, Fox KA, et al. Rimonabant for prevention of cardiovascular events (CRESCENDO): a randomised, multicentre, placebo-controlled trial. Lancet. 2010;376(9740):517–23. Epub 2010/08/17.PubMedCrossRefGoogle Scholar
  41. 41.
    James WP, Caterson ID, Coutinho W, et al. Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects. N Engl J Med. 2010;363(10):905–17. Epub 2010/09/08.PubMedCrossRefGoogle Scholar
  42. 42.
    Franco M, Bilal U, Ordunez P, et al. Population-wide weight loss and regain in relation to diabetes burden and cardiovascular mortality in Cuba 1980-2010: repeated cross sectional surveys and ecological comparison of secular trends. BMJ. 2013;346:f1515. Epub 2013/04/11.PubMedCrossRefGoogle Scholar
  43. 43.
    DeMaria EJ, Pate V, Warthen M, et al. Baseline data from American Society for Metabolic and Bariatric Surgery-designated bariatric surgery centers of excellence using the bariatric outcomes longitudinal database. Surgery Obes Relat Dis: Off J Am Soc Bariatric Surg. 2010;6(4):347–55. Epub 2010/02/24.CrossRefGoogle Scholar
  44. 44.
    Jemal A, Siegel R, Xu J, et al. Cancer statistics, 2010. CA: Cancer J Clin. 2010;60(5):277–300. Epub 2010/07/09.Google Scholar
  45. 45.
    Bastard JP, Maachi M, Lagathu C, et al. Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw. 2006;17(1):4–12. Epub 2006/04/15.PubMedGoogle Scholar
  46. 46.
    de Visser KE, Eichten A, Coussens LM. Paradoxical roles of the immune system during cancer development. Nat Rev Cancer. 2006;6(1):24–37. Epub 2006/01/07.PubMedCrossRefGoogle Scholar
  47. 47.
    Modesitt SC, Huang B, Shelton BJ, et al. Endometrial cancer in Kentucky: the impact of age, smoking status, and rural residence. Gynecol Oncol. 2006;103(1):300–6. Epub 2006/04/25.PubMedCrossRefGoogle Scholar
  48. 48.
    Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420(6917):860–7. Epub 2002/12/20.PubMedCentralPubMedCrossRefGoogle Scholar
  49. 49.
    Ashrafian H, Ahmed K, Rowland SP, et al. Metabolic surgery and cancer: protective effects of bariatric procedures. Cancer. 2011;117(9):1788–99. Epub 2011/04/22.PubMedCrossRefGoogle Scholar
  50. 50.
    Parker ED, Folsom AR. Intentional weight loss and incidence of obesity-related cancers: the Iowa Women's Health Study. Int J Obes Relat Metab Disord: J Int Assoc Study Obes. 2003;27(12):1447–52. Epub 2003/11/25.CrossRefGoogle Scholar
  51. 51.
    Esposito K, Chiodini P, Colao A, et al. Metabolic syndrome and risk of cancer: a systematic review and meta-analysis. Diabetes Care. 2012;35(11):2402–11. Epub 2012/10/25.PubMedCentralPubMedCrossRefGoogle Scholar
  52. 52.
    Unick JL, Beavers D, Jakicic JM, et al. Effectiveness of lifestyle interventions for individuals with severe obesity and type 2 diabetes: results from the Look AHEAD trial. Diabetes Care. 2011;34(10):2152–7. Epub 2011/08/13.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Daniela Schaan Casagrande
    • 1
    • 2
  • Daniela Dornelles Rosa
    • 3
  • Daniel Umpierre
    • 4
  • Roberta Aguiar Sarmento
    • 1
  • Clarissa Garcia Rodrigues
    • 5
    • 6
  • Beatriz D. Schaan
    • 1
    • 4
  1. 1.Postgraduate Program in Medical Sciences: Endocrinology and Metabolism, Universidade Federal do Rio Grande do SulHospital de Clínicas de Porto AlegrePorto AlegreBrazil
  2. 2.Obesity and Metabolic Syndrome Center of Hospital São LucasPontifícia Universidade Católica do Rio Grande do Sul (COM HSL-PUCRS)Porto AlegreBrazil
  3. 3.Oncology UnitHospital Moinhos de VentoPorto AlegreBrazil
  4. 4.Postgraduate Program in Health Sciences: Cardiovascular Sciences, Universidade Federal do Rio Grande do SulHospital de Clinicas de Porto AlegrePorto AlegreBrazil
  5. 5.Fundação Universitária de CardiologiaInstituto de Cardiologia do Rio Grande do Sul (IC-FUC)Porto AlegreBrazil
  6. 6.Duke Global Health Institute (DGHI)Duke UniversityDurhamUSA

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