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Bariatric Surgery Is Associated with a Recent Temporal Increase in Colorectal Cancer Resections, Most Pronounced in Adults Below 50 Years of Age

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Abstract

Background

Colorectal cancer incidence is rising in adults < 50 years old, possibly due to obesity. Having bariatric surgery (BRS) should hypothetically reduce this trend, but data are limited. This study compared trends of colorectal cancer (CRC) versus other obesity-related gastrointestinal cancers (OGCs) between morbidly obese and post-BRS subjects.

Material and Methods

This retrospective cohort study investigated OGC resection trends using the 2006–2013 National Inpatient Sample. Patients with prior BRS and non-BRS controls with body mass index ≥ 40 kg/m2 were included (n = 30,279 total). We divided OGCs into CRC and non-CRC OGCs (esophageal, stomach, liver, gallbladder, and pancreas). We calculated OGC resection trends in patients < 50 and ≥ 50 years old using the average annual percent change (AAPC).

Results

BRS patients with OGCs were younger (59.3 vs 62.3 years old), with more female gender (77.4% vs 57.1%) and White race (72.6% vs 67%) compared with controls (p < 0.05). The number of CRC resections increased across all ages in 2006–2013, especially rectal cancer for BRS patients (AAPC + 19.8%, p = 0.04). The steepest rise in early-onset CRC resections was after BRS versus a lesser increase in morbid obesity controls (AAPC + 18.7% and + 13.7%, respectively, p < 0.001). In contrast, non-CRC OGCs increased in our controls but not post-BRS. In a sensitivity analysis, estimated CRC incidence trends also increased post-BRS despite adjusting for increasing BRS prevalence.

Conclusion

Our findings suggest that bariatric surgery is associated with a persistent increase in early-onset CRC trends. Studies are warranted to validate our results and test the impact of bariatric surgery on early-onset CRC biological mechanisms.

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Abbreviations

AHRQ:

Agency for Healthcare Research and Quality

AAPC:

Average annual percent change

BRS:

Bariatric surgery

BMI:

Body mass index

CRC:

Colorectal cancer

NIS-HCUP:

Nationwide Inpatient Sample-Healthcare Cost and Utilization Project

NRD:

Nationwide Readmission Database

NHANES:

National Health and Nutritional Examination Survey

OGC:

Obesity-Related gastrointestinal cancer

RYGB:

Roux-en-Y gastric bypass surgery

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Authors and Affiliations

  1. Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Ohio State University, 395 W 12th Ave, Suite 250, Columbus, OH, 43210, USA

    Hisham Hussan & Samuel Akinyeye

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

    Hisham Hussan

  3. Department of Internal Medicine, Ohio State University, Columbus, OH, USA

    Arsheya Patel

  4. Center for Biostatistics, Department of Biomedical Informatics, Ohio State University Wexner Medical Center, Columbus, OH, USA

    Kyle Porter

  5. Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado Hospital, Aurora, CO, USA

    Dennis Ahnen

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

    David Lieberman

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  1. Hisham Hussan
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  2. Arsheya Patel
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  3. Samuel Akinyeye
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Contributions

Dr. Hussan was involved in the conception, design, and interpretation of data and the manuscript’s drafting and critical revision. Mr. Kyle Porter was involved in the study’s design, acquired and statistically analyzed the data, and provided a critical revision of the manuscript. The above authors had full access to all the data in the study and take responsibility for the data’s integrity and the data analysis’ accuracy. Drs. Patel, Akinyeye, Lieberman, and Ahnen were involved in the design, data interpretation, and critical revision of the manuscript. All gave final approval of the submitted manuscript and take responsibility for the integrity of the work.

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Correspondence to Hisham Hussan.

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Hussan, H., Patel, A., Akinyeye, S. et al. Bariatric Surgery Is Associated with a Recent Temporal Increase in Colorectal Cancer Resections, Most Pronounced in Adults Below 50 Years of Age. OBES SURG 30, 4867–4876 (2020). https://doi.org/10.1007/s11695-020-04902-9

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