Meta-analysis of gastric and esophageal cancer incidence in obese patients after bariatric surgery

GUO Xiao-jing; ZHONG Qing; SHANGGUAN Zhi-Xin; JIANG Yi-ming; CHEN Qi-yue; LU Jun; WANG Jia-bin; XIE Jian-wei; LI Ping; ZHENG Zhao-hui; HUANG Chang-ming; LIN Jian-xian

doi:10.19538/j.cjps.issn1005-2208.2024.01.17

Abstract：Objective To systematically evaluate the incidence of gastric and esophageal cancer for obesity patients after weight loss surgery.Methods Cochrane Library,Embase,PubMed,China Knowledge,and Wanfang databases were systematically searched and screened to find studies on the incidence of gastric and esophageal cancers in the population after bariatric surgery based on the inclusion and exclusion criteria,with a search period from 2000 to July 15,2023.Literature was screened independently by 2 investigators,and Meta-analysis was performed using RevMan 5.4 and STATA 16.0 software after extracting data information from the literature and evaluating the methodological quality of the included studies.Results Seven cohort studies on the incidence of gastric cancer and 11 cohort studies related to the incidence of esophageal cancer were finally included.Meta-analysis showed that the incidence of gastric cancer after bariatric surgery was comparable to that of obese patients who did not undergo the surgery(RR 0.59,95％CI 0.31-1.14,P=0.12);whereas,the overall incidence of esophageal cancer after undergoing bariatric surgery was significantly lower than that of the non-operated obese patients(RR 0.61,95％CI 0.37-1.00,P=0.05).Subgroup analysis of esophageal cancer incidence showed that bariatric surgery was associated with a reduced incidence of esophageal cancer when the median age of patients was ≤42 years(RR 0.44,95％CI 0.20-0.99,P≤0.05),and stratification according to duration of follow-up revealed that a follow-up period of ≤5 years after bariatric surgery was associated with a significantly lower incidence of esophageal cancer(RR 0.45,95％CI 0.29-0.70,P=0.0003),while at a mean follow-up time of＞5 years,there was no statistically significant difference in postoperative esophageal cancer incidence between patients in the bariatric surgery group and those in the non-surgical group(P＞0.5).Sensitivity analysis showed good stability,reliable conclusions,and no significant publication bias.Conclusion Compared with morbidly obese patients who did not undergo bariatric surgery,the incidence of gastric cancer in patients who underwent bariatric surgery was comparable to that of nonsurgical obese patients,whereas the overall incidence of esophageal cancer was significantly lower after undergoing bariatric surgery.