Colorectal cancer after bariatric surgery (Cric-Abs 2020): Sicob (Italian society of obesity surgery) endorsed national survey

Abstract

BACKGROUND:The published colorectal cancer (CRC) outcomes after bariatric surgery (BS) are conflicting, with some anecdotal studies reporting increased risks. The present nationwide survey CRIC-ABS 2020 (Colo-Rectal Cancer Incidence-After Bariatric Surgery-2020), endorsed by the Italian Society of Obesity Surgery (SICOB), aims to report its incidence in Italy after BS, comparing the two commonest laparoscopic procedures-Sleeve Gastrectomy (SG) and Roux-en-Y gastric bypass (GBP). METHODS: Two online questionnaires-first having 11 questions on SG/GBP frequency with a follow-up of 5-10 years, and the second containing 15 questions on CRC incidence and management, were administered to 53 referral bariatric, high volume centers. A standardized incidence ratio (SIR-a ratio of the observed number of cases to the expected number) with 95% confidence intervals (CI) was calculated along with CRC incidence risk computation for baseline characteristics. RESULTS: Data for 20,571 patients from 34 (63%) centers between 2010 and 2015 were collected, of which 14,431 had SG (70%) and 6140 GBP (30%). 22 patients (0.10%, mean age = 53 ± 12 years, 13 males), SG: 12 and GBP: 10, developed CRC after 4.3 ± 2.3 years. Overall incidence was higher among males for both groups (SG: 0.15% vs 0.05%; GBP: 0.35% vs 0.09%) and the GBP cohort having slightly older patients. The right colon was most affected (n = 13) and SIR categorized/sex had fewer values < 1, except for GBP males (SIR = 1.07). CONCLUSION: Low CRC incidence after BS at 10 years (0.10%), and no difference between procedures was seen, suggesting that BS does not trigger the neoplasm development.

Sex-Dependent Differences in Colorectal Cancer: With a Focus on Obesity

“…The French population study also reported that the same age group of obese patients who did not undergo bariatric surgery have a 34% higher risk of developing CRC compared to patients who have undergone bariatric surgery. A similar observation of the reduced risk of developing CRC after bariatric surgery was reported in the population studies of Italy [ 56 ], England [ 57 ], and the US [ 58 , 59 ]. Furthermore, a meta-analysis study by an Australian research team found that obesity in young adults, especially increased weight change at a young age from early adulthood to midlife, is associated with a higher risk of CRC than those who develop obesity at an older age from midlife to old age [ 60 ].…”

Does Bariatric Surgery Reduce the Risk of Colorectal Cancer in Individuals with Morbid Obesity? A Systematic Review and Meta-Analysis

“…As shown in Figure 1 , we included 18 [ 2 , 6 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] studies in the quantitative and qualitative analysis. A meta-analysis was conducted on 12,517,893 patients.…”

Safety and efficacy of totally minimally invasive right colectomy in the obese patients: a multicenter propensity score-matched analysis

“…Nevertheless, the increased prevalence of obesity has caused an increase even in the prevalence of colorectal cancers [ 5 ].…”