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7 juli 2022: Bron: JAMA. 2022;327(24):2423-2433 3 juni 2022

Bij volwassenen met obesitas - overgewicht blijkt bariatrische chirurgie beduidend minder aan obesitas - zwaarlijvigheid gerelateerde kanker te geven (ongeveer 40 procent) en minder aan kanker gerelateerde mortaliteit vergeleken met geen operatie (s). Dat blijkt uit een 10 jarige retrospectieve studie waarbij totaal 30318 patiënten (inclusief 5053 patiënten die bariatrische chirurgie ondergingen en 25265 gematchte patiënten in de niet-chirurgische controlegroep)

De onderzoekers onder leiding van hoofdonderzoeker Ali Aminian, M.D., werkzaam in de Cleveland Clinic ontdekten dat het gemiddelde verschil in lichaamsgewicht tussen de groepen na 10 jaar 24,8 kg was (19,2 procent meer gewichtsverlies in de bariatrische chirurgiegroep).

Tijdens de follow-up werd bij 96 patiënten in de bariatrische chirurgiegroep en bij 780 patiënten in de niet-chirurgische groep een diagnose gesteld van een van de 13 aan obesitas gerelateerde vormen van kanker (cumulatieve incidentie na 10 jaar was 2,9 procent in de bariatrische chirurgiegroep en 4,9 procent in de niet-chirurgische controlegroep groep).

In de bariatrische chirurgiegroep waren er 21 gevallen van aan kanker gerelateerde overlijdens versus 205 gevallen in de niet-chirurgische controlegroep, met een cumulatieve incidentie van kankergerelateerde mortaliteit na 10 jaar van respectievelijk 0,8 en 1,4 procent.

Belangrijkste punten uit deze studie:

Vraag
Is er een verband tussen bariatrische chirurgie en de incidentie van aan obesitas gerelateerde kanker en kankergerelateerde mortaliteit bij patiënten met obesitas?

Bevindingen
In deze retrospectieve cohortstudie van 30318 patiënten (inclusief 5053 patiënten die bariatrische chirurgie ondergingen en 25265 gematchte patiënten in de niet-chirurgische controlegroep), was bariatrische chirurgie significant geassocieerd met een lager risico op met obesitas geassocieerde kanker (hazard ratio, 0,68) en kankergerelateerde sterfte (hazard ratio, 0,52).

Betekenis
Bij volwassenen met obesitas was bariatrische chirurgie vergeleken met geen operatie geassocieerd met een significant lagere incidentie van aan obesitas gerelateerde kanker en aan kanker gerelateerde mortaliteit.

Het volledige studierapport is tegen bepaalde voorwaarden of betaling in te zien bij JAMA. Hier het abstract van de studie:

June 3, 2022

Association of Bariatric Surgery With Cancer Risk and Mortality in Adults With Obesity

Ali Aminian, MD¹; Rickesha Wilson, MD¹; Abbas Al-Kurd, MD¹; et alChao Tu, MS²; Alex Milinovich, BA²; Matthew Kroh, MD¹; Raul J. Rosenthal, MD³; Stacy A. Brethauer, MD⁴; Philip R. Schauer, MD⁵; Michael W. Kattan, PhD²; Justin C. Brown, PhD⁶; Nathan A. Berger, MD⁷; Jame Abraham, MD⁸; Steven E. Nissen, MD⁹

Author Affiliations

JAMA. 2022;327(24):2423-2433. doi:10.1001/jama.2022.9009

Key Points

Question Is there an association between bariatric surgery and the incidence of obesity-associated cancer and cancer-related mortality in patients with obesity?

Findings In this retrospective cohort study of 30 318 patients (including 5053 patients who underwent bariatric surgery and 25 265 matched patients in the nonsurgical control group), bariatric surgery was significantly associated with a lower risk of obesity-associated cancer (hazard ratio, 0.68) and cancer-related mortality (hazard ratio, 0.52).

Meaning Among adults with obesity, bariatric surgery compared with no surgery was associated with a significantly lower incidence of obesity-associated cancer and cancer-related mortality.

Abstract

Importance Obesity increases the incidence and mortality from some types of cancer, but it remains uncertain whether intentional weight loss can decrease this risk.

Objective To investigate whether bariatric surgery is associated with lower cancer risk and mortality in patients with obesity.

Design, Setting, and Participants In the SPLENDID (Surgical Procedures and Long-term Effectiveness in Neoplastic Disease Incidence and Death) matched cohort study, adult patients with a body mass index of 35 or greater who underwent bariatric surgery at a US health system between 2004 and 2017 were included. Patients who underwent bariatric surgery were matched 1:5 to patients who did not undergo surgery for their obesity, resulting in a total of 30 318 patients. Follow-up ended in February 2021.

Exposures Bariatric surgery (n = 5053), including Roux-en-Y gastric bypass and sleeve gastrectomy, vs nonsurgical care (n = 25 265).

Main Outcomes and Measures Multivariable Cox regression analysis estimated time to incident obesity-associated cancer (a composite of 13 cancer types as the primary end point) and cancer-related mortality.

Results The study included 30 318 patients (median age, 46 years; median body mass index, 45; 77% female; and 73% White) with a median follow-up of 6.1 years (IQR, 3.8-8.9 years). The mean between-group difference in body weight at 10 years was 24.8 kg (95% CI, 24.6-25.1 kg) or a 19.2% (95% CI, 19.1%-19.4%) greater weight loss in the bariatric surgery group. During follow-up, 96 patients in the bariatric surgery group and 780 patients in the nonsurgical control group had an incident obesity-associated cancer (incidence rate of 3.0 events vs 4.6 events, respectively, per 1000 person-years). The cumulative incidence of the primary end point at 10 years was 2.9% (95% CI, 2.2%-3.6%) in the bariatric surgery group and 4.9% (95% CI, 4.5%-5.3%) in the nonsurgical control group (absolute risk difference, 2.0% [95% CI, 1.2%-2.7%]; adjusted hazard ratio, 0.68 [95% CI, 0.53-0.87], P = .002). Cancer-related mortality occurred in 21 patients in the bariatric surgery group and 205 patients in the nonsurgical control group (incidence rate of 0.6 events vs 1.2 events, respectively, per 1000 person-years). The cumulative incidence of cancer-related mortality at 10 years was 0.8% (95% CI, 0.4%-1.2%) in the bariatric surgery group and 1.4% (95% CI, 1.1%-1.6%) in the nonsurgical control group (absolute risk difference, 0.6% [95% CI, 0.1%-1.0%]; adjusted hazard ratio, 0.52 [95% CI, 0.31-0.88], P = .01).

Conclusions and Relevance Among adults with obesity, bariatric surgery compared with no surgery was associated with a significantly lower incidence of obesity-associated cancer and cancer-related mortality.

June 8, 2022

Primary Prevention of Obesity

Harry Wetzler, MD, MSPH | Independent Analyst

Aminian and colleagues state "Bariatric surgery is the most effective currently available treatment for obesity." However, their study population had a median body mass index (BMI) greater than 45. Less invasive interventions among those with moderate obesity need to be considered. In a study with mean baseline BMI=31.5, Liu et al reported that over 60% of study participants had sustained weight loss equal to or greater than 5% after 12 months of daily calorie restriction (DCR) (1). Many experts consider 5% weight loss to be clinically significant (2).

Although significant weight loss is possible with DCR, long-term maintenance is much more challenging (3). Yet recently, Rinott and colleagues reported diet-induced weight loss maintenance using diet-modulated autologous fecal microbiota transplantation (FMT) (4,5). Since many people will find FMT repugnant if not distasteful, I suggest more emphasis be placed on primary prevention of obesity.

References

1. Liu D, Huang Y, Huang C, et al. Calorie Restriction with or without Time-Restricted Eating in Weight Loss. N Engl J Med. 2022;386(16):1495-1504.
2. Horn DB, Almandoz JP, Look M. What is clinically relevant weight loss for your patients and how can it be achieved? A narrative review. Postgrad Med. 2022;1-17.
3. Hall KD, Kahan S, Diseases K. Maintenance of lost weight. Med Clin North Am. 2018;102(1):183-197.
4. Rinott E, Youngster I, Yaskolka Meir A, et al. Effects of Diet-Modulated Autologous Fecal Microbiota Transplantation on Weight Regain. Gastroenterology. 2021;160(1):158-173.
5. Nieuwdorp M, Madsen K. The Promise of Maintaining Diet-Induced Weight Loss by Swallowing One’s Own Feces: Time to Provide a Do-It-Yourself Manual? Gastroenterology. 2021;160(1):17-19.

CONFLICT OF INTEREST: None Reported

obesitas, Bariatrische chirurgie, maagverkleining, kanker gerelateerd, mortaliteit