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



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.


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.


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.

Graphical abstract

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Fig. 1
Fig. 2



Acquired immunodeficiency syndromes


Bariatric surgery


Body mass index


Charlson comorbidity index


Confidence interval


Current procedural terminology


Colorectal cancer


Healthy eating index


Human immunodeficiency virus


Hazards ratio


Kaplan Meier


Odds ratio


Roux-En-Y gastric bypass


Short-chain fatty acid


Vertical sleeve gastrectomy


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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



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).

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