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Mezzapesa F, Di Costanzo S, Coadă CA, Bernante P, Balsamo F, Garelli S, Genovesi L, Pasquini P, Lambertini A, Caramelli F, De Iaco P, Perrone AM. Combined robotic surgery for concomitant treatment of endometrial cancer and obesity. Surg Endosc 2024:10.1007/s00464-024-11274-z. [PMID: 39320546 DOI: 10.1007/s00464-024-11274-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Accepted: 09/11/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Endometrial Cancer (EC) is strongly linked to obesity. Bariatric surgery is recognized as a long-term solution for weight loss in severely obese patients. This pilot study investigates the feasibility, intraoperative and 30-day morbidity outcomes of integrating gynecological surgical staging and bariatric robotic surgery in class II and III obese patients affected by early EC or Endometrial Intraepithelial Neoplasia (EIN). METHODS Patients aged over 18 years old with early EC or EIN and class II and III obesity (Body mass index (BMI) ≥ 35 kg/m2) who are surgical and anesthesiologic candidates. Standard robotic surgery for early EC staging performed alone (THBSO group) or in conjunction with sleeve gastrectomy (THBSO + SG group) for obesity management was proposed. RESULTS Of the 13 patients who met the inclusion criteria, 5 (38.46%) opted for combined surgery. The groups showed a significant difference in preoperative BMI (49.68 kg/m2 vs. 40.24 kg/m2 p = 0.017 with and without SG), preoperative weight (143.92 kg vs. 105.62 kg p = 0.004 with and without SG), preoperative (p = 0.01) and postoperative (p = 0.005) aspartate transaminase (AST). The THBSO + SG group had higher anesthesia induction end-tidal carbon dioxide (ETCO2) (p = 0.05), final Partial pressure of carbon dioxide (PaCO2) (p = 0.044), anesthesia induction lactate (p = 0.001) and final lactate (p = 0.011) without a significant difference in final pH (p = 0.31). Operative time was longer in the THBSO + SG group (p < 0.001), but this did not result in longer ICU (p = 0.351), total hospital stays (p = 0.208), nor increased blood loss and transfusion. The simultaneous combined approach had an 80% success rate. At 6 months, the THBSO + SG group achieved significantly greater weight loss than the THBSO group (ΔBMI - 11.81 kg/m2 vs - 1.72 kg/m2, p = 0.003, with and without SG). CONCLUSION Integrating robotic EC staging with SG in obese women with early EC increased the operative time without increasing intraoperative risks, early and 30 days post-surgery complication and offering a promising approach to simultaneously treating both conditions.
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Affiliation(s)
- Francesco Mezzapesa
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Stella Di Costanzo
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Camelia Alexandra Coadă
- Faculty of Medicine, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Paolo Bernante
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Division of Metabolic and Bariatric Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesca Balsamo
- Division of Metabolic and Bariatric Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Silvia Garelli
- Endocrinology and Diabetes Prevention and Care Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Lucia Genovesi
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Pietro Pasquini
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Agnese Lambertini
- Anesthesiology and General and Pediatric Resuscitation Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Fabio Caramelli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Anesthesiology and General and Pediatric Resuscitation Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Anna Myriam Perrone
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Shieh C, Thompson HJ, McLaughlin E, Chiang CW, Hussan H. Advancements in Understanding and Preventing Obesity-Related Colon Cancer. Cancer J 2024; 30:357-369. [PMID: 39312456 DOI: 10.1097/ppo.0000000000000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
ABSTRACT Obesity and colorectal cancer are global public health issues, with the prevalence of both conditions increasing over the last 4 decades. In the United States alone, the prevalence of obesity is greater than 40%, and this percentage is projected to increase past 50% by 2030. This review focuses on understanding the association between obesity and the risk of colorectal cancer while also highlighting hypotheses about molecular mechanisms underlying the link between these disease processes. We also consider whether those linkages can be disrupted via weight loss therapies, including lifestyle modifications, pharmacotherapy, bariatric surgery, and endobariatrics.
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Affiliation(s)
- Christine Shieh
- From the Department of Gastroenterology, University of California, Davis, Sacramento, CA
| | - Henry J Thompson
- Cancer Prevention Laboratory, Colorado State University, Fort Collins, CO
| | | | - Chien-Wei Chiang
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
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Hussan H, Ali MR, Lyo V, Webb A, Pietrzak M, Zhu J, Choueiry F, Li H, Cummings BP, Marco ML, Medici V, Clinton SK. Bariatric Surgery Is Associated with Lower Concentrations of Fecal Secondary Bile Acids and Their Metabolizing Microbial Enzymes: A Pilot Study. Obes Surg 2024; 34:3420-3433. [PMID: 39042309 DOI: 10.1007/s11695-024-07420-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 07/04/2024] [Accepted: 07/17/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Excess body fat elevates colorectal cancer risk. While bariatric surgery (BRS) induces significant weight loss, its effects on the fecal stream and colon biology are poorly understood. Specifically, limited data exist on the impact of bariatric surgery (BRS) on fecal secondary bile acids (BA), including lithocholic acid (LCA), a putative promotor of colorectal carcinogenesis. METHODS This cross-sectional case-control study included 44 patients with obesity; 15 pre-BRS (controls) vs. 29 at a median of 24.1 months post-BRS. We examined the fecal concentrations of 11 BA by liquid chromatography and gene abundance of BA-metabolizing bacterial enzymes through fecal metagenomic sequencing. Differences were quantified using non-parametric tests for BA levels and linear discriminant analysis (LDA) effect size (LEfSe) for genes encoding BA-metabolizing enzymes. RESULTS Total fecal secondary BA concentrations trended towards lower levels post- vs. pre-BRS controls (p = 0.07). Individually, fecal LCA concentrations were significantly lower post- vs. pre-BRS (8477.0 vs. 11,914.0 uM/mg, p < 0.008). Consistent with this finding, fecal bacterial genes encoding BA-metabolizing enzymes, specifically 3-betahydroxycholanate-3-dehydrogenase (EC 1.1.1.391) and 3-alpha-hydroxycholanate dehydrogenase (EC 1.1.1.52), were also lower post- vs. pre-BRS controls (LDA of - 3.32 and - 2.64, respectively, adjusted p < 0.0001). Post-BRS fecal BA concentrations showed significant inverse correlations with weight loss, a healthy diet quality, and increased physical activity. CONCLUSIONS Concentrations of LCA, a secondary BA, and bacterial genes needed for BA metabolism are lower post-BRS. These changes can impact health and modulate the colorectal cancer cascade. Further research is warranted to examine how surgical alterations and the associated dietary changes impact bile acid metabolism.
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Affiliation(s)
- Hisham Hussan
- Division of Gastroenterology, Department of Internal Medicine, University of California, Davis, Sacramento, CA, 95616, USA.
- The UC Davis Comprehensive Cancer Center, Sacramento, CA, 95616, USA.
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, UC Davis Medical Center, 4150 V Street, Suite 3500, Sacramento, CA, 95817, USA.
| | - Mohamed R Ali
- Division of Foregut, Metabolic, and General Surgery, Department of Surgery, University of California Davis, Sacramento, CA, 95616, USA
- Center for Alimentary and Metabolic Sciences, Department of Surgery, University of California, Davis, Sacramento, CA, 95616, USA
| | - Victoria Lyo
- Division of Foregut, Metabolic, and General Surgery, Department of Surgery, University of California Davis, Sacramento, CA, 95616, USA
- Center for Alimentary and Metabolic Sciences, Department of Surgery, University of California, Davis, Sacramento, CA, 95616, USA
| | - Amy Webb
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, 43210, USA
| | - Maciej Pietrzak
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, 43210, USA
| | - Jiangjiang Zhu
- The Department of Human Sciences, The Ohio State University, Columbus, OH, 43210, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Fouad Choueiry
- The Department of Human Sciences, The Ohio State University, Columbus, OH, 43210, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
| | - Hong Li
- The UC Davis Comprehensive Cancer Center, Sacramento, CA, 95616, USA
- Division of Biostatistics, Public Health Sciences, University of California Davis, Davis, CA, 95616, USA
| | - Bethany P Cummings
- Center for Alimentary and Metabolic Sciences, Department of Surgery, University of California, Davis, Sacramento, CA, 95616, USA
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA, 95616, USA
| | - Maria L Marco
- Department of Food Science and Technology, University of California Davis, Davis, CA, 95616, USA
| | - Valentina Medici
- Division of Gastroenterology, Department of Internal Medicine, University of California, Davis, Sacramento, CA, 95616, USA
| | - Steven K Clinton
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, 43210, USA
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Müller L, Hoffmann A, Bernhart SH, Ghosh A, Zhong J, Hagemann T, Sun W, Dong H, Noé F, Wolfrum C, Dietrich A, Stumvoll M, Massier L, Blüher M, Kovacs P, Chakaroun R, Keller M. Blood methylation pattern reflects epigenetic remodelling in adipose tissue after bariatric surgery. EBioMedicine 2024; 106:105242. [PMID: 39002385 PMCID: PMC11284569 DOI: 10.1016/j.ebiom.2024.105242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND Studies on DNA methylation following bariatric surgery have primarily focused on blood cells, while it is unclear to which extend it may reflect DNA methylation profiles in specific metabolically relevant organs such as adipose tissue. Here, we investigated whether adipose tissue depots specific methylation changes after bariatric surgery are mirrored in blood. METHODS Using Illumina 850K EPIC technology, we analysed genome-wide DNA methylation in paired blood, subcutaneous and omental visceral AT (SAT/OVAT) samples from nine individuals (N = 6 female) with severe obesity pre- and post-surgery. FINDINGS The numbers and effect sizes of differentially methylated regions (DMRs) post-bariatric surgery were more pronounced in AT (SAT: 12,865 DMRs from -11.5 to 10.8%; OVAT: 14,632 DMRs from -13.7 to 12.8%) than in blood (9267 DMRs from -8.8 to 7.7%). Cross-tissue DMRs implicated immune-related genes. Among them, 49 regions could be validated with similar methylation changes in blood from independent individuals. Fourteen DMRs correlated with differentially expressed genes in AT post bariatric surgery, including downregulation of PIK3AP1 in both SAT and OVAT. DNA methylation age acceleration was significantly higher in AT compared to blood, but remained unaffected after surgery. INTERPRETATION Concurrent methylation pattern changes in blood and AT, particularly in immune-related genes, suggest blood DNA methylation mirrors AT's inflammatory state post-bariatric surgery. FUNDING The funding sources are listed in the Acknowledgments section.
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Affiliation(s)
- Luise Müller
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, 04103, Germany
| | - Anne Hoffmann
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, Leipzig, 04103, Germany
| | - Stephan H Bernhart
- Interdisciplinary Center for Bioinformatics, University of Leipzig, 04107, Leipzig, Germany; Bioinformatics Group, Department of Computer, University of Leipzig, 04107, Leipzig, Germany; Transcriptome Bioinformatics, LIFE Research Center for Civilization Diseases, University of Leipzig, 04107, Leipzig, Germany
| | - Adhideb Ghosh
- Institute of Food, Nutrition and Health, ETH Zurich, 8092, Schwerzenbach, Switzerland
| | - Jiawei Zhong
- Department of Medicine Huddinge (H7), Karolinska Institutet, Karolinska University Hospital Huddinge, 141 83, Huddinge, Sweden
| | - Tobias Hagemann
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, Leipzig, 04103, Germany
| | - Wenfei Sun
- Institute of Food, Nutrition and Health, ETH Zurich, 8092, Schwerzenbach, Switzerland
| | - Hua Dong
- Institute of Food, Nutrition and Health, ETH Zurich, 8092, Schwerzenbach, Switzerland
| | - Falko Noé
- Institute of Food, Nutrition and Health, ETH Zurich, 8092, Schwerzenbach, Switzerland
| | - Christian Wolfrum
- Institute of Food, Nutrition and Health, ETH Zurich, 8092, Schwerzenbach, Switzerland
| | - Arne Dietrich
- Leipzig University Hospital, Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Section of Bariatric Surgery, 04103, Leipzig, Germany
| | - Michael Stumvoll
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, 04103, Germany; Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, Leipzig, 04103, Germany; Deutsches Zentrum für Diabetesforschung e.V., 85764, Neuherberg, Germany
| | - Lucas Massier
- Department of Medicine Huddinge (H7), Karolinska Institutet, Karolinska University Hospital Huddinge, 141 83, Huddinge, Sweden
| | - Matthias Blüher
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, 04103, Germany; Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, Leipzig, 04103, Germany; Deutsches Zentrum für Diabetesforschung e.V., 85764, Neuherberg, Germany
| | - Peter Kovacs
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, 04103, Germany; Deutsches Zentrum für Diabetesforschung e.V., 85764, Neuherberg, Germany
| | - Rima Chakaroun
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, 04103, Germany; The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 41345, Gothenburg, Sweden
| | - Maria Keller
- Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, 04103, Germany; Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Center Munich at the University of Leipzig and University Hospital Leipzig, Leipzig, 04103, Germany.
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Miranda BCJ, Tustumi F, Nakamura ET, Shimanoe VH, Kikawa D, Waisberg J. Obesity and Colorectal Cancer: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1218. [PMID: 39202500 PMCID: PMC11355959 DOI: 10.3390/medicina60081218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/21/2024] [Accepted: 07/24/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: Cancer is a multicausal disease, and environmental, cultural, socioeconomic, lifestyle, and genetic factors can influence the risk of developing cancer. Colorectal cancer (CRC) stands as the third most common cancer globally. Some countries have observed a rise in the incidence of CRC, especially among young people. This increase is associated with lifestyle changes over the last few decades, including changes in diet patterns, a sedentary lifestyle, and obesity. Currently, obesity and overweight account for approximately 39% of the world's population and increase the risk of overall mortality of certain cancer types. This study aims to conduct a literature review examining the association between obesity and CRC. Materials and Methods: This narrative review explored the pathophysiological mechanisms, treatment strategies, and challenges related to obesity and CRC. Results: Several studies have established a clear causal relationship between obesity and CRC, showing that individuals with morbid obesity are at a higher risk of developing colorectal cancer. The adipose tissue, particularly the visceral, secretes proinflammatory cytokines, such as TNF-alpha, interleukin-6, and C-reactive protein. Chronic inflammation is closely linked to cancer initiation and progression, with a complex interplay of molecular mechanisms underlying this association. Obesity can complicate the treatment of CRC due to several factors, reducing the therapeutic effectiveness and increasing the risk for adverse events during treatment. Dietary modification, calorie restriction, and other types of weight-control strategies can reduce the risk of CRC development and improve treatment outcomes. Conclusions: Obesity is intricately linked to CRC development and progression, making it a crucial target for intervention, whether through diet therapy, physical exercises, medical therapy, or bariatric surgery.
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Affiliation(s)
- Bárbara Cristina Jardim Miranda
- Department of Surgery, Instituto de Assistência Médica ao Servidor Público Estadual—IAMSPE, Sao Paulo 04029-000, SP, Brazil
- Department of Surgery, Faculdade de Medicina do ABC—FMABC, Santo Andre 09060-870, SP, Brazil
| | - Francisco Tustumi
- Department of Gastroenterology, Faculty of Medicine, Universidade de São Paulo—USP, Sao Paulo 14040-903, SP, Brazil
- Department of Health Sciences, Sociedade Beneficente Israelita Brasileira Albert Einstein, Sao Paulo 05652-900, SP, Brazil
| | - Eric Toshiyuki Nakamura
- Department of Gastroenterology, Faculty of Medicine, Universidade de São Paulo—USP, Sao Paulo 14040-903, SP, Brazil
| | - Victor Haruo Shimanoe
- Department of Gastroenterology, Faculty of Medicine, Universidade de São Paulo—USP, Sao Paulo 14040-903, SP, Brazil
| | - Daniel Kikawa
- Department of Gastroenterology, Faculty of Medicine, Universidade de São Paulo—USP, Sao Paulo 14040-903, SP, Brazil
| | - Jaques Waisberg
- Department of Surgery, Instituto de Assistência Médica ao Servidor Público Estadual—IAMSPE, Sao Paulo 04029-000, SP, Brazil
- Department of Surgery, Faculdade de Medicina do ABC—FMABC, Santo Andre 09060-870, SP, Brazil
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Feitosa IDAF, de Souza Castro CC, de Araújo AIN, Coutinho BS, Meneses do Rêgo AC, de Moura Santos E, de Medeiros KS, Araújo-Filho I. Obesity-related cancer and bariatric surgery: A comprehensive systematic review and meta-analysis protocol. PLoS One 2024; 19:e0306623. [PMID: 39042663 PMCID: PMC11265695 DOI: 10.1371/journal.pone.0306623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/17/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION Obesity is a silent pandemic affecting all ages and is a component of metabolic syndrome. Its treatment is conducted by lifestyle and behavioral changes, pharmacological therapy, and when correctly indicated, bariatric surgery. In recent years, the procedures for weight loss have been investigated due to their relationship with the development of many types of cancer. Although many studies have shown that bariatric surgery decreases cancer risk, other researchers observed an increase in this association. Carcinogenesis is affected by many factors, such as age, sex, type of cancer, and the bariatric surgery performed on each patient. This systematic review and meta-analysis protocol aims to clarify the association between the different modalities of bariatric surgery and the risk of cancer development in adult patients with metabolic syndrome. METHOD AND ANALYSIS The proposed systematic review and meta-analysis will be reported conforming to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) guidelines. This research will include observational studies (case-control and cohort studies) about patients who undergo bariatric surgery due to metabolic syndrome. Will be accepted in any language and any year. Publications without peer review will be excluded from this review. Data will be entered into the Review Manager software (RevMan5.2.3). We extracted or calculated the OR and 95% CI for dichotomous outcomes for each study. In case of heterogeneity (I2>50%), the random-effects model will combine the studies to calculate the OR and 95% CI. ETHICS AND DISSEMINATION This study will review the published data; Thus, obtaining ethical approval is unnecessary. The findings of this systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023432079.
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Affiliation(s)
- Isadora de Albuquerque Falcão Feitosa
- Instituto de Ensino, Pesquisa e Inovação. Liga Contra o Câncer, Natal, Rio Grande do Norte, Brazil
- Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Caio Cesar de Souza Castro
- Instituto de Ensino, Pesquisa e Inovação. Liga Contra o Câncer, Natal, Rio Grande do Norte, Brazil
- Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - André Igor Nogueira de Araújo
- Instituto de Ensino, Pesquisa e Inovação. Liga Contra o Câncer, Natal, Rio Grande do Norte, Brazil
- Potiguar University, Natal, Rio Grande do Norte, Brazil
| | - Bárbara Scarlett Coutinho
- Instituto de Ensino, Pesquisa e Inovação. Liga Contra o Câncer, Natal, Rio Grande do Norte, Brazil
- Potiguar University, Natal, Rio Grande do Norte, Brazil
| | - Amália Cínthia Meneses do Rêgo
- Instituto de Ensino, Pesquisa e Inovação. Liga Contra o Câncer, Natal, Rio Grande do Norte, Brazil
- Potiguar University, Natal, Rio Grande do Norte, Brazil
| | - Edilmar de Moura Santos
- Instituto de Ensino, Pesquisa e Inovação. Liga Contra o Câncer, Natal, Rio Grande do Norte, Brazil
| | | | - Irami Araújo-Filho
- Instituto de Ensino, Pesquisa e Inovação. Liga Contra o Câncer, Natal, Rio Grande do Norte, Brazil
- Potiguar University, Natal, Rio Grande do Norte, Brazil
- Department of Surgery, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Anazco D, Acosta A, Cathcart-Rake EJ, D'Andre SD, Hurtado MD. Weight-centric prevention of cancer. OBESITY PILLARS 2024; 10:100106. [PMID: 38495815 PMCID: PMC10943063 DOI: 10.1016/j.obpill.2024.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024]
Abstract
Background The link between excess adiposity and carcinogenesis has been well established for multiple malignancies, and cancer is one of the main contributors to obesity-related mortality. The potential role of different weight-loss interventions on cancer risk modification has been assessed, however, its clinical implications remain to be determined. In this clinical review, we present the data assessing the effect of weight loss interventions on cancer risk. Methods In this clinical review, we conducted a comprehensive search of relevant literature using MEDLINE, Embase, Web of Science, and Google Scholar databases for relevant studies from inception to January 20, 2024. In this clinical review, we present systematic reviews and meta-analysis, randomized clinical trials, and prospective and retrospective observational studies that address the effect of different treatment modalities for obesity in cancer risk. In addition, we incorporate the opinions from experts in the field of obesity medicine and oncology regarding the potential of weight loss as a preventative intervention for cancer. Results Intentional weight loss achieved through different modalities has been associated with a reduced cancer incidence. To date, the effect of weight loss on the postmenopausal women population has been more widely studied, with multiple reports indicating a protective effect of weight loss on hormone-dependent malignancies. The effect of bariatric interventions as a protective intervention for cancer has been studied extensively, showing a significant reduction in cancer incidence and mortality, however, data for the effect of bariatric surgery on certain specific types of cancer is conflicting or limited. Conclusion Medical nutrition therapy, exercise, antiobesity medication, and bariatric interventions, might lead to a reduction in cancer risk through weight loss-dependent and independent factors. Further evidence is needed to better determine which population might benefit the most, and the amount of weight loss required to provide a clinically significant preventative effect.
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Affiliation(s)
- Diego Anazco
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andres Acosta
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Maria D. Hurtado
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
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Zha JM, Zhang M, Wang T, Li HS, Ban QY, Liu M, Jiang XX, Guo SY, Wang J, Zhou YR, Liu YH, He WQ, Xu H. Association of Overweight and Inflammatory Indicators with Breast Cancer: A Cross-Sectional Study in Chinese Women. Int J Womens Health 2024; 16:783-795. [PMID: 38737496 PMCID: PMC11086397 DOI: 10.2147/ijwh.s428696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/26/2024] [Indexed: 05/14/2024] Open
Abstract
Objective This cross-sectional study aimed to explore the association of overweight and inflammatory indicators with breast cancer risk in Chinese patients. Methods Weight, height, and peripheral blood inflammatory indicators, including white blood cell count (WBC), neutrophil count (NE), lymphocyte count (LY), platelet count (PLT) and the concentration of hypersensitivity C-reactive protein (hsCRP), were collected in 383 patients with benign breast lumps (non-cancer) and 358 patients with malignant breast tumors (cancer) at the First Affiliated Hospital of Soochow University, China, from March 2018 to July 2020. Body mass index (BMI), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) were determined according to the ratio equation. The correlations among overweight, inflammatory indicators, and the proportion of non-cancer or cancer cases were analyzed. Results BMI is associated with an increased breast cancer risk. Compared with non-cancer patients, the average WBC count, NE count, NLR, and level of hsCRP were significantly higher in cancer patients. The level of hsCRP was closely associated with the size of malignant breast tumors. Conclusion We conclude that overweight and high levels of hsCRP may serve as putative risk factors for malignant breast tumors in Chinese women.
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Affiliation(s)
- Juan-Min Zha
- Department of Oncology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, People’s Republic of China
| | - Mei Zhang
- Department of Oncology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, People’s Republic of China
| | - Tao Wang
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Cambridge-Suda (CAM-SU) Genomic Resource Center, Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Hua-Shan Li
- Department of Oncology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, People’s Republic of China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Cambridge-Suda (CAM-SU) Genomic Resource Center, Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Quan-Yao Ban
- Department of Oncology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, People’s Republic of China
| | - Mei Liu
- Department of Oncology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, People’s Republic of China
| | - Xue-Xue Jiang
- Department of Oncology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, People’s Republic of China
| | - Shi-Ying Guo
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Cambridge-Suda (CAM-SU) Genomic Resource Center, Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jing Wang
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Cambridge-Suda (CAM-SU) Genomic Resource Center, Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Ya-Ru Zhou
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Cambridge-Suda (CAM-SU) Genomic Resource Center, Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Yu-Hong Liu
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Cambridge-Suda (CAM-SU) Genomic Resource Center, Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Wei-Qi He
- Department of Oncology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, People’s Republic of China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Cambridge-Suda (CAM-SU) Genomic Resource Center, Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Hong Xu
- Department of Oncology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, People’s Republic of China
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9
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O'Brien JW, Merali N, Pring C, Rockall T, Robertson D, Bartlett D, Frampton A. Gastrointestinal Permeability After Bariatric Surgery: A Systematic Review. Cureus 2024; 16:e60480. [PMID: 38883053 PMCID: PMC11180380 DOI: 10.7759/cureus.60480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/18/2024] Open
Abstract
Gastrointestinal permeability refers to the movement of substances across the gut wall. This is mediated by endotoxemia (bacterial products entering the systemic circulation), and is associated with metabolic disease. The effect of bariatric surgery on permeability remains uncertain; the associated dietary, metabolic and weight changes are suggested to influence, or trigger, altered permeability. The primary aim of this study is to synthesize evidence and analyze the effect of bariatric surgery on permeability. A systematic review was performed, searching MEDLINE, EMBASE, and Scopus until February 2023, using MESH terms "intestinal permeability", "bariatric", for studies reporting in vivo assessment of permeability. Three cohort studies and two case series were identified (n=96). Data was heterogeneous; methodology and controls preclude meta-analysis. Gastroduodenal permeability reduced post-sleeve gastrectomy (SG). Two studies showed an increase in small intestinal permeability after biliopancreatic diversion. Two studies revealed a decrease in post-Roux-en-Y gastric bypass. One study identified increased colonic permeability six months post-SG. Evidence regarding permeability change after bariatric surgery is conflicting, notably for the small intestine. Impaired colonic permeability post-SG raises concerns regarding colonic protein fermentation and harmful dietary sequelae. There are multiple interacting variables confounding gastrointestinal permeability change; procedure type, altered microbiota and metabolic response to surgery. Further understanding of this important aspect of obesity is required, both before and after bariatric surgery.
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Affiliation(s)
- James W O'Brien
- Department of Surgery, School of Biosciences and Medicine, University of Surrey, Guildford, GBR
- Department of Minimal Access Therapy Training Unit, Royal Surrey NHS Foundation Trust, Guildford, GBR
| | - Nabeel Merali
- Department of Surgery, School of Biosciences and Medicine, University of Surrey, Guildford, GBR
- Department of Minimal Access Therapy Training Unit, Royal Surrey NHS Foundation Trust, Guildford, GBR
| | - Chris Pring
- Department of Bariatric Surgery, University Hospitals Sussex NHS Foundation Trust, Chichester, GBR
| | - Tim Rockall
- Department of Minimal Access Therapy Training Unit, Royal Surrey NHS Foundation Trust, Guildford, GBR
| | - Denise Robertson
- Department of Nutrition, School of Biosciences and Medicine, University of Surrey, Guildford, GBR
| | - David Bartlett
- Department of Nutrition, School of Biosciences and Medicine, University of Surrey, Guildford, GBR
| | - Adam Frampton
- Department of Surgery, School of Biosciences and Medicine, University of Surrey, Guildford, GBR
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10
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Zhu C, Liu W, Hu D, Peng L. Risk of Esophageal Adenocarcinoma After Bariatric Surgery: A Meta-Analysis of Retrospective Studies. Obes Surg 2024; 34:1726-1736. [PMID: 38536625 DOI: 10.1007/s11695-024-07190-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE This study aims to systematically review and meta-analyze the evidence on the risk of esophageal adenocarcinoma (EAC) following metabolic and bariatric surgery (MBS). MATERIALS AND METHODS A systematic literature search was conducted on the China National Knowledge Infrastructure (CNKI), Wanfang, EMBASE, MEDLINE, Web of Science, The Cochrane Library, and PubMed databases. Meta-analysis utilized odds ratios (ORs) and 95% confidence intervals (CIs) to analyze the correlation between MBS and the risk of EAC. Meta-analysis was performed using STATA software (version 12.0). RESULTS Fourteen studies involving patients with obesity undergoing bariatric surgery and control groups receiving conventional treatment were included. The meta-analysis indicated a reduction in the overall incidence of esophageal cancer after bariatric surgery (OR = 0.69, 95% CI: 0.51-0.95, P = 0.022). Subgroup analysis results demonstrated a decreased risk of EAC in European patients with obesity undergoing MBS treatment (OR: 0.60, 95% CI: 0.38-0.95, P = 0.028). In studies with a sample size greater than or equal to 100,000 patients, the risk of EAC in patients with obesity undergoing MBS was significantly lower than the non-surgery group (OR: 0.59, 95% CI: 0.42-0.83, P = 0.003). Articles published before 2020 and those published in 2020 or earlier showed a significant difference in the incidence of EAC between the surgery and non-surgery groups (OR: 0.57, 95% CI: 0.43-0.75, P < 0.001). The risk of EAC in patients with obesity with a follow-up time of less than 5 years was statistically significant (OR: 0.46, 95% CI: 0.25-0.82, P = 0.009). CONCLUSION Our meta-analysis results suggest a reduced risk of esophageal cancer in patients with obesity after bariatric surgery. PROSPERO REGISTRATION CRD 42024505177.
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Affiliation(s)
- Chenglou Zhu
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
- Department of Surgical Oncology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Wenhan Liu
- Department of Anorectal Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China.
| | - Dongping Hu
- Department of Anorectal Surgery, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Lingzhi Peng
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
- Department of Surgical Oncology, Gansu Provincial Hospital, Lanzhou, 730000, China
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11
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Chen ZW, Jin T, Liang PP, Li ZD, He FJ, Chen ZH, Song XH, Zhu YF, Hu JK, Yang K. Incidence of cancer for patients after bariatric surgery: evidence from 33 cohort studies. Surg Obes Relat Dis 2024; 20:467-481. [PMID: 38151417 DOI: 10.1016/j.soard.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 10/30/2023] [Accepted: 11/18/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND With the rising prevalence of severe obesity, bariatric surgery has emerged as a crucial treatment option. As the number of surgeries performed worldwide increases, there has been growing interest in the impact of bariatric surgery on cancer incidence. While several studies have examined this relationship, the topic remains controversial. OBJECTIVES We conducted this systematic review of cohort studies with meta-analysis to evaluate the effect of bariatric surgery versus nonsurgical treatment on overall cancer incidence. However, the effects may vary when focusing on specific cancer types, surgical procedures, or gender, so we conducted additional subgroup analyses. SETTING A meta-analysis. University hospital. METHODS The Cochrane, Embase, PubMed, and Web of Science databases were searched for studies from 1 January 2000 to 1 December 2022. Meta-analysis was conducted to evaluate the pooled effect and further implemented subgroup analysis stratified by cancer type, operation type, and sex. RESULTS All cohort studies were included in this meta-analysis from 18,216 studies. The overall cancer incidence demonstrated a significant decrease in the group with bariatric surgery (odds ratios [OR] = .56, P = .000, 95% CI .46 to .68). In subgroup analysis, similar decrease effect was found in 9 cancers. Furthermore, the incidence of cancer decreased significantly in male (OR = .66, P = .001, 95% CI .51 to .85) and female patients (OR = .63, P = .000, 95% CI .57 to .69) and patients undergoing gastric bypass (OR = .46, P = .000, 95% CI .33 to .63) or sleeve gastrectomy (OR = .44, P = .001, 95% CI .27 to .70). CONCLUSIONS In the overall analysis, bariatric surgery could reduce the incidence of cancer significantly. Further large-scale well-matched studies are needed to verify the protective effect of bariatric surgery on cancer incidence.
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Affiliation(s)
- Zheng-Wen Chen
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Tao Jin
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Pan-Ping Liang
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ze-Dong Li
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Feng-Jun He
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ze-Hua Chen
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiao-Hai Song
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yun-Feng Zhu
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jian-Kun Hu
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Kun Yang
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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12
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Happonen N, Härma MA, Akhi R, Nissinen AE, Savolainen MJ, Ruuth M, Öörni K, Adeshara K, Lehto M, Groop PH, Koivukangas V, Hukkanen J, Hörkkö S. Impact of RYGB surgery on plasma immunoglobulins: association between blood pressure and glucose levels six months after surgery. APMIS 2024; 132:187-197. [PMID: 38149431 DOI: 10.1111/apm.13366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/23/2023] [Indexed: 12/28/2023]
Abstract
We aimed to study levels of natural antibodies in plasma, and their associations to clinical and fecal biomarkers, before and 6 months after Roux-en-Y gastric bypass (RYGB) surgery. Thirty individuals with obesity [16 type 2 diabetic, 14 non-diabetic (ND)] had RYGB surgery. Total plasma IgA, IgG and IgM antibody levels and specific antibodies to oxidized low-density lipoprotein (oxLDL), malondialdehyde-acetaldehyde adducts, Porphyromonas gingivalis gingipain A hemagglutinin domain (Rgp44), and phosphocholine were measured using chemiluminescence immunoassay. Associations between plasma and fecal antibodies as well as clinical markers were analyzed. RYGB surgery reduced blood pressure, and the glycemic state was improved. A higher level of diastolic blood pressure was associated with lower plasma antibodies to oxLDL after surgery. Also, lower level of glucose markers associated with lower level of plasma antibodies to bacterial virulence factors. Antibodies to oxLDL decreased after surgery, and positive association between active serum lipopolysaccharide and specific oxLDL antibodies was detected. Total IgG levels decreased after surgery, but only in ND individuals. Reduced level of total plasma IgG, improved state of hypertension and hyperglycemia and their associations with decreased levels of specific antibodies in plasma, suggest an improved state of systemic inflammation after RYGB surgery.
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Affiliation(s)
- Natalie Happonen
- Medical Microbiology and Immunology, Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Nordlab, Oulu University Hospital, Oulu, Finland
| | - Mari-Anne Härma
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ramin Akhi
- Medical Microbiology and Immunology, Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Antti E Nissinen
- Medical Microbiology and Immunology, Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland
| | - Markku J Savolainen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Biomedicine and Internal Medicine and Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Maija Ruuth
- Atherosclerosis Research Laboratory, Wihuri Research Institute, Helsinki, Finland
| | - Katariina Öörni
- Atherosclerosis Research Laboratory, Wihuri Research Institute, Helsinki, Finland
- Molecular and Integrative Biosciences, Faculty of Biological and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Krishna Adeshara
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Markku Lehto
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Vesa Koivukangas
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Janne Hukkanen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Biomedicine and Internal Medicine and Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Sohvi Hörkkö
- Medical Microbiology and Immunology, Research Unit of Biomedicine and Internal Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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13
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Lim PW, Stucky CCH, Wasif N, Etzioni DA, Harold KL, Madura JA, Ven Fong Z. Bariatric Surgery and Longitudinal Cancer Risk: A Review. JAMA Surg 2024; 159:331-338. [PMID: 38294801 DOI: 10.1001/jamasurg.2023.5809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Importance Cancer is one of the leading causes of death in the United States, with the obesity epidemic contributing to its steady increase every year. Recent cohort studies find an association between bariatric surgery and reduced longitudinal cancer risk, but with heterogeneous findings. Observations This review summarizes how obesity leads to an increased risk of developing cancer and synthesizes current evidence behind the potential for bariatric surgery to reduce longitudinal cancer risk. Overall, bariatric surgery appears to have the strongest and most consistent association with decreased incidence of developing breast, ovarian, and endometrial cancers. The association of bariatric surgery and the development of esophageal, gastric, liver, and pancreas cancer is heterogenous with studies showing either no association or decreased longitudinal incidences. Conversely, there have been preclinical and cohort studies implying an increased risk of developing colon and rectal cancer after bariatric surgery. A review and synthesis of the existing literature reveals epidemiologic shortcomings of cohort studies that potentially explain incongruencies observed between studies. Conclusions and Relevance Studies examining the association of bariatric surgery and longitudinal cancer risk remain heterogeneous and could be explained by certain epidemiologic considerations. This review provides a framework to better define subgroups of patients at higher risk of developing cancer who would potentially benefit more from bariatric surgery, as well as subgroups where more caution should be exercised.
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Affiliation(s)
- Pei-Wen Lim
- Division of General Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix
| | - Chee-Chee H Stucky
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix
| | - Nabil Wasif
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix
| | - David A Etzioni
- Division of General Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix
| | - Kristi L Harold
- Division of General Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix
| | - James A Madura
- Division of General Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix
| | - Zhi Ven Fong
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix
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14
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Karabacak U, Mollaoglu MC, Seven TE, Karadayi K. Gastric pouch cancer after mini gastric bypass surgery: The first case report. J Cancer Res Ther 2024; 20:472-475. [PMID: 38554368 DOI: 10.4103/jcrt.jcrt_1749_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2023]
Abstract
Development of gastric cancer following bariatric surgery is very rare. Nearly all patients with cancer after mini gastric bypass/one anastomosis gastric bypass have carcinoma in their remnant stomach. This is the first case with the development of gastric cancer in the gastric pouch following mini gastric bypass surgery. Our case was a 32-year-old woman who was admitted to our department with oral intolerance 5 years after mini gastric bypass. In her endoscopic examination, an ulcerovegetan mass in the gastric pouch (Siewert type III) was detected. The pathological examination of the biopsies was reported as low differentiated adenocarcinoma. Clinical staging was performed using Positron emission tomographycomputed tomography (PET-CT) and endoscopic ultrasonography (T3N1M0). Following four cycles of neoadjuvant chemotherapy, en-bloc total gastrectomy, D2 lymph node dissection, and partial small intestine resection were performed. In pathological evaluation, no tumors were detected in the specimen and a total of 38 lymph nodes were dissected. This finding was accepted as a pathologic complete response. Signs and symptoms such as anemia, oral intolerance, and vomiting that develop after bariatric surgery can often be attributed to the surgical procedure performed, but it should be kept in mind that similar symptoms may also be associated with malignancy. In case of clinical suspicion, endoscopic examination and cross-sectional imaging should be performed.
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Affiliation(s)
- Ufuk Karabacak
- Department of Surgical Oncology, Numune Hospital, Sivas, Turkey
| | | | - Turan Eray Seven
- Department of Surgical Oncology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Kursat Karadayi
- Department of Surgical Oncology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey
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15
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Hussan H, Clinton SK, Grainger EM, Webb M, Wang C, Webb A, Needleman B, Noria S, Zhu J, Choueiry F, Pietrzak M, Bailey MT. Distinctive patterns of sulfide- and butyrate-metabolizing bacteria after bariatric surgery: potential implications for colorectal cancer risk. Gut Microbes 2023; 15:2255345. [PMID: 37702461 PMCID: PMC10501170 DOI: 10.1080/19490976.2023.2255345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/09/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
Despite improved cardiometabolic outcomes following bariatric surgery, its long-term impact on colorectal cancer (CRC) risk remains uncertain. In parallel, the influence of bariatric surgery on the host microbiome and relationships with disease outcomes is beginning to be appreciated. Therefore, we investigated the impact of Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) on the patterns of sulfide-reducing and butyrate-producing bacteria, which are hypothesized to modulate CRC risk after bariatric surgery. In this single-center, cross-sectional study, we included 15 pre-surgery subjects with severe obesity and patients who are at a median (range) of 25.6 (9.9-46.5) months after RYGB (n = 16) or VSG (n = 10). The DNA abundance of fecal bacteria and enzymes involved in butyrate and sulfide metabolism were identified using metagenomic sequencing. Differences between pre-surgery and post-RYGB or post-VSG cohorts were quantified using the linear discriminant analysis (LDA) effect size (LEfSe) method. Our sample was predominantly female (87%) with a median (range) age of 46 (23-71) years. Post-RYGB and post-VSG patients had a higher DNA abundance of fecal sulfide-reducing bacteria than pre-surgery controls (LDA = 1.3-4.4, p < .05). The most significant enrichments were for fecal E. coli, Acidaminococcus and A. finegoldii after RYGB, and for A. finegoldii, S. vestibularis, V. parvula after VSG. As for butyrate-producing bacteria, R. faecis was more abundant, whereas B. dentium and A. hardus were lower post-RYGB vs. pre-surgery. B. dentium was also lower in post-VSG vs. pre-surgery. Consistent with these findings, our analysis showed a greater enrichment of sulfide-reducing enzymes after bariatric surgery, especially RYGB, vs. pre-surgery. The DNA abundance of butyrate-producing enzymes was lower post-RYGB. In conclusion, the two most used bariatric surgeries, RYGB and VSG, are associated with microbiome patterns that are potentially implicated in CRC risk. Future studies are needed to validate and understand the impact of these microbiome changes on CRC risk after bariatric surgery.
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Affiliation(s)
- Hisham Hussan
- Division of Gastroenterology, Department of Internal Medicine, University of California, Davis; Sacramento, CA, USA
- The UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Steven K. Clinton
- Division of Medical Oncology; Department of Internal Medicine, The Ohio StateUniversity, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Elizabeth M. Grainger
- Division of Medical Oncology; Department of Internal Medicine, The Ohio StateUniversity, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Maxine Webb
- Division of Medical Oncology; Department of Internal Medicine, The Ohio StateUniversity, Columbus, OH, USA
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Cankun Wang
- Division of Biomedical Informatics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Amy Webb
- Division of Biomedical Informatics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Bradley Needleman
- Center for Minimally Invasive Surgery; Department of General Surgery, The Ohio State University, Columbus, OH, USA
| | - Sabrena Noria
- Center for Minimally Invasive Surgery; Department of General Surgery, The Ohio State University, Columbus, OH, USA
| | - Jiangjiang Zhu
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Fouad Choueiry
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- The Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Maciej Pietrzak
- Division of Biomedical Informatics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Michael T. Bailey
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children’s Hospital and Department of Pediatrics, Columbus, OH, USA
- The Oral and Gastrointestinal Microbiology Research Affinity Group, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
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16
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Hardvik Åkerström J, Santoni G, von Euler Chelpin M, Chidambaram S, Markar SR, Maret-Ouda J, Ness-Jensen E, Kauppila JH, Holmberg D, Lagergren J. Decreased Risk of Esophageal Adenocarcinoma After Gastric Bypass Surgery in a Cohort Study From 3 Nordic Countries. Ann Surg 2023; 278:904-909. [PMID: 37450697 DOI: 10.1097/sla.0000000000006003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The objective of this study was to test the hypothesis that bariatric surgery decreases the risk of esophageal and cardia adenocarcinoma. BACKGROUND Obesity is strongly associated with esophageal adenocarcinoma and moderately with cardia adenocarcinoma, but whether weight loss prevents these tumors is unknown. METHODS This population-based cohort study included patients with an obesity diagnosis in Sweden, Finland, or Denmark. Participants were divided into a bariatric surgery group and a nonoperated group. The incidence of esophageal and cardia adenocarcinoma (ECA) was first compared with the corresponding background population by calculating standardized incidence ratios (SIR) with 95% CIs. Second, the bariatric surgery group and the nonoperated group were compared using multivariable Cox regression, providing hazard ratios (HR) with 95% CI, adjusted for sex, age, comorbidity, calendar year, and country. RESULTS Among 748,932 participants with an obesity diagnosis, 91,731 underwent bariatric surgery, predominantly gastric bypass (n=70,176; 76.5%). The SIRs of ECA decreased over time after gastric bypass, from SIR=2.2 (95% CI, 0.9-4.3) after 2 to 5 years to SIR=0.6 (95% CI, <0.1-3.6) after 10 to 40 years. Gastric bypass patients were also at a decreased risk of ECA compared with nonoperated patients with obesity [adjusted HR=0.6, 95% CI, 0.4-1.0 (0.98)], with decreasing point estimates over time. Gastric bypass was followed by a strongly decreased adjusted risk of esophageal adenocarcinoma (HR=0.3, 95% CI, 0.1-0.8) but not of cardia adenocarcinoma (HR=0.9, 95% CI, 0.5-1.6), when analyzed separately. There were no consistent associations between other bariatric procedures (mainly gastroplasty, gastric banding, sleeve gastrectomy, and biliopancreatic diversion) and ECA. CONCLUSIONS Gastric bypass surgery may counteract the development of esophageal adenocarcinoma in morbidly obese individuals.
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Affiliation(s)
- Johan Hardvik Åkerström
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Karolinska University Hospital, Sweden
| | - Giola Santoni
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Karolinska University Hospital, Sweden
| | | | - Swathikan Chidambaram
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Karolinska University Hospital, Sweden
| | - Sheraz R Markar
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Karolinska University Hospital, Sweden
- Nuffield Department of Surgery, University of Oxford, United Kingdom
| | - John Maret-Ouda
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Eivind Ness-Jensen
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Karolinska University Hospital, Sweden
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim/Levanger, Norway
- Medical Department, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Joonas H Kauppila
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Karolinska University Hospital, Sweden
- Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Dag Holmberg
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Karolinska University Hospital, Sweden
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, and Karolinska University Hospital, Sweden
- School of Cancer and Pharmaceutical Sciences, King's College London, United Kingdom
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17
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Liu YN, Gu JF, Zhang J, Xing DY, Wang GQ. Bariatric surgery reduces colorectal cancer incidence in obese individuals: Systematic review and meta-analysis. World J Gastrointest Surg 2023; 15:2331-2342. [PMID: 37969715 PMCID: PMC10642476 DOI: 10.4240/wjgs.v15.i10.2331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Colorectal cancer ranks third in global cancer prevalence and stands as the second leading cause of cancer-related mortalities. With obesity recognized as a pivotal risk factor for colorectal cancer, the potential protective role of bariatric surgery, especially laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy, has garnered attention. AIM To investigate the Roux-en-Y gastric bypass (RYGB) vs sleeve gastrectomy (SG) effect on colorectal cancer incidence in obese individuals. METHODS A systematic review and meta-analysis of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Seventeen studies with a total of 12497322 patients were included. The primary outcome was the relative risk (RR) of developing colorectal cancer in obese patients who underwent weight loss surgery compared to those who did not. Secondary outcomes included determining the RR for colon and rectal cancer separately and subgroup analyses by gender and type of weight loss surgery. RESULTS The meta-analysis revealed a 54% reduction in colorectal cancer risk in morbidly obese patients who underwent bariatric surgery compared to those who did not. A significant 46% reduction in colorectal cancer risk was observed among female patients. However, no significant differences were found in the meta-analysis for various types of bariatric surgery, such as SG and RYGB. CONCLUSION This meta-analysis reveals weight loss surgery, regardless of type, reduces colorectal cancer risk, especially in women, as indicated by RR and hazard ratio assessments. Further validation is essential.
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Affiliation(s)
- Ying-Ning Liu
- Department of Gastrointestinal Surgery, The First Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Jing-Feng Gu
- Department of Gastrointestinal Surgery, The First Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Jian Zhang
- Department of Gastrointestinal Surgery, The First Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Dong-Yang Xing
- Department of Gastrointestinal Surgery, The First Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Gui-Qi Wang
- Department of Gastrointestinal Surgery, The First Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
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18
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Macleod A, Scheurlen KM, Burton JF, Parks MA, Sumy MSA, Gaskins JT, Galandiuk S. Systemic adiponectin levels in colorectal cancer and adenoma: a systematic review and meta-analysis. Int J Obes (Lond) 2023; 47:911-921. [PMID: 37626126 DOI: 10.1038/s41366-023-01358-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/07/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Obesity is a well-established risk factor in the development of colorectal cancer; however, the mechanism mediating this relationship is not well understood. The adipokine, adiponectin, has an inverse relationship with obesity. Experimental studies have shown adiponectin to have dichotomous inflammatory and tumorigenic roles. Its role in the development of colorectal cancer, including the potential effect of its increase following bariatric surgery, is not yet clear. There are conflicting results from studies evaluating this relationship. This study sought to provide a systematic review and meta-analysis to examine the association between systemic adiponectin levels in patients with colorectal cancer and adenoma. METHODS An electronic literature search was performed using PubMed, EMBASE, Web of Science as well as gray literature. Articles were screened for inclusion criteria and assessed for quality using the Newcastle-Ottawa Scale. Pooled mean differences were calculated using a random effects model. Subgroup and meta-regression analyses were performed to identify potential sources of heterogeneity. RESULTS Thirty-two observational studies comparing systemic adiponectin in colorectal cancer vs healthy controls were included. Colorectal cancer cases had lower systemic adiponectin levels (overall pooled mean difference = -1.05 μg/ml [95% CI: -1.99; -0.12] p = 0.03); however, significant heterogeneity was present (I2 = 95% p < 0.01). Subgroup and meta- regression analyses results could not identify a source of the significant heterogeneity across the studies. CONCLUSIONS Studies suggest a trend towards lower systemic adiponectin levels in colorectal cancer patients, but the heterogeneity observed showed current evidence is not sufficient to definitively draw any conclusions. These data, however, suggest rising adiponectin is unlikely to account for the reported observation of increased CRC following bariatric surgery. Further studies with prospective age, race, and BMI-matched cohorts, and standardized adiponectin measurements may provide a better understanding of this relationship.
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Affiliation(s)
- Anne Macleod
- Price Institute of Surgical Research, Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Katharina M Scheurlen
- Price Institute of Surgical Research, Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - James F Burton
- Price Institute of Surgical Research, Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Mary Alex Parks
- Price Institute of Surgical Research, Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Mst Sharmin Akter Sumy
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA
| | - Jeremy T Gaskins
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY, USA
| | - Susan Galandiuk
- Price Institute of Surgical Research, Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
- Hiram C. Polk Jr. MD Department of Surgery, University of Louisville, Louisville, KY, USA.
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19
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Luna Aufroy A, Rebasa Cladera P, Montmany Vioque S. Barrett's esophagus and esophageal cancer after sleeve gastrectomy. Myth or reality? Cir Esp 2023; 101 Suppl 4:S39-S42. [PMID: 37979936 DOI: 10.1016/j.cireng.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/13/2023] [Indexed: 11/20/2023]
Abstract
Sleeve gastrectomy has become the most performed bariatric surgery technique in the world. This bariatric technique has been related to the appearance of gastroesophageal reflux and recently with de novo Barrett's esophagus. It is not clear that this leads to an increased incidence of esophageal adenocarcinoma. In this review we analyze the current scientific literature to try to answer the true incidence of Barrett's esophagus and adenocarcinoma after sleeve gastrectomy, and whether these data should make us change the indications for this technique.
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Affiliation(s)
- Alexis Luna Aufroy
- Servicio de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain.
| | - Pere Rebasa Cladera
- Servicio de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
| | - Sandra Montmany Vioque
- Servicio de Cirugía General, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
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20
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Adams TD, Meeks H, Fraser A, Davidson LE, Holmen J, Newman M, Ibele AR, Playdon M, Hardikar S, Richards N, Hunt SC, Kim J. Long-term cancer outcomes after bariatric surgery. Obesity (Silver Spring) 2023; 31:2386-2397. [PMID: 37605634 PMCID: PMC10449359 DOI: 10.1002/oby.23812] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/22/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE Obesity is associated with increased cancer risk. Because of the substantial and sustained weight loss following bariatric surgery, postsurgical patients are ideal to study the association of weight loss and cancer. METHODS Retrospectively (1982-2019), 21,837 bariatric surgery patients (surgery, 1982-2018) were matched 1:1 by age, sex, and BMI with a nonsurgical comparison group. Procedures included gastric bypass, gastric banding, sleeve gastrectomy, and duodenal switch. Primary outcomes included cancer incidence and mortality, stratified by obesity- and non-obesity-related cancers, sex, cancer stage, and procedure. RESULTS Bariatric surgery patients had a 25% lower risk of developing any cancers compared with a nonsurgical comparison group (hazard ratio [HR] 0.75; 95% CI 0.69-0.81; p < 0.001). Cancer incidence was lower among female (HR 0.67; 95% CI 0.62-0.74; p < 0.001) but not male surgery patients, with the HR lower for females than for males (p < 0.001). Female surgery patients had a 41% lower risk for obesity-related cancers (i.e., breast, ovarian, uterine, and colon) compared with nonsurgical females (HR 0.59; 95% CI 0.52-0.66; p < 0.001). Cancer mortality was significantly lower after surgery in females (HR 0.53; 95% CI 0.44-0.64; p < 0.001). CONCLUSIONS Bariatric surgery was associated with lower all-cancer and obesity-related cancer incidence among female patients. Cancer mortality was significantly lower among females in the surgical group versus the nonsurgical group.
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Affiliation(s)
- Ted D. Adams
- Intermountain Surgical Specialties/Digestive Health Clinical Program, Intermountain Healthcare, Salt Lake City, Utah, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah, USA
| | - Huong Meeks
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Alison Fraser
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Lance E. Davidson
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Exercise Sciences, Brigham Young University, Provo, Utah, USA
| | - John Holmen
- Intermountain Biorepository, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Michael Newman
- University of Utah Health, Data Science Services, Salt Lake City, Utah, USA
| | - Anna R. Ibele
- Division of General Surgery, Department of General Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Mary Playdon
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Sheetal Hardikar
- Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Nathan Richards
- Intermountain Surgical Specialties/Digestive Health Clinical Program, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Steven C. Hunt
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Genetic Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Jaewhan Kim
- Department of Physical Therapy, College of Health, University of Utah, Salt Lake City, Utah, USA
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21
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Lee J, Kim SY. [Obesity and Colorectal Cancer]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2023; 82:63-72. [PMID: 37621241 DOI: 10.4166/kjg.2023.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
The prevalence of obesity has increased significantly worldwide, and this trend is likely to continue in the coming years. There is substantial evidence that obesity plays a crucial role in the development of colorectal cancer. Epidemiological data have consistently demonstrated a correlation between obesity and colorectal cancer. Insulin resistance, hyperinsulinemia, chronic inflammation, altered levels of growth factors, adipocytokines, and various hormones are plausible biological mechanisms. In addition, obesity has been shown to have an impact on recurrence, treatment success, and overall survival. There are some reports, although the evidence is not conclusive, that weight loss and lifestyle changes such as dietary modification and physical activity can reduce the risk of colorectal cancer. The understanding that obesity is a potentially modifiable risk factor that can affect the incidence and prognosis of colorectal cancer is crucial knowledge that can have an impact on the prevention and treatment of the condition.
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Affiliation(s)
- Jundeok Lee
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Su Young Kim
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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22
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Li W, Xu Y, Zeng X, Tan J, Wang Y, Wu H, Li M, Yi C. Etiological relationship between lipid metabolism and endometrial carcinoma. Lipids Health Dis 2023; 22:116. [PMID: 37537560 PMCID: PMC10401764 DOI: 10.1186/s12944-023-01868-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/05/2023] [Indexed: 08/05/2023] Open
Abstract
Endometrial carcinoma (EC) has become one of the most common gynecological malignant neoplasms in developed countries worldwide. Studies have shown that this may be closely related to the abnormal metabolism of blood lipids, which was the most significant metabolic change in the human body in this cancer. In this review, we focus on the correlation between lipid metabolism and EC and discuss the evidence that abnormal lipid metabolism promotes an increase in EC growth and metabolism, as well as the regulatory mechanism and related signaling pathways involved in this relationship. In addition, we also discussed the research progress of targeted therapies and drug treatments for EC that act on lipid metabolism, and statins are expected to become adjuvant drugs for EC in the future. This review will provide a systematic view for a better understanding of the etiological relationship between lipid metabolism and EC and further open up new therapeutic possibilities and effective treatments for EC by targeting lipid metabolism.
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Affiliation(s)
- Wenzhe Li
- Department of Endocrinology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Yi Xu
- Department of Endocrinology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Xinling Zeng
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Jie Tan
- Department of Hematology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Ya Wang
- Department of Endocrinology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China.
- Department of Hubei Provincial Clinical Research Center for Personalized Diagnosis and Treatment of Cancer, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China.
| | - Hongyan Wu
- Department of Endocrinology, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | - Maokun Li
- Department of Hubei Provincial Clinical Research Center for Personalized Diagnosis and Treatment of Cancer, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China.
| | - Cunjian Yi
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China.
- Department of Hubei Provincial Clinical Research Center for Personalized Diagnosis and Treatment of Cancer, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China.
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23
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Davey MG, Ryan OK, Ryan ÉJ, Donlon NE, Reynolds IS, Fearon NM, Martin ST, Heneghan HM. The Impact of Bariatric Surgery on the Incidence of Colorectal Cancer in Patients with Obesity-a Systematic Review and Meta-analysis of Registry Data. Obes Surg 2023; 33:2293-2302. [PMID: 37341934 PMCID: PMC10345076 DOI: 10.1007/s11695-023-06674-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/23/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Cancer and obesity represent two of the most significant global health concerns. The risk of malignancy, including colorectal cancer (CRC), increases with obesity. The aim of this study was to perform a systematic review and meta-analysis to determine the value of bariatric surgery in reducing CRC risk in patients with obesity using registry data. MATERIALS AND METHODS A systematic review and meta-analysis were performed as per PRISMA guidelines. The risk of CRC was expressed as a dichotomous variable and reported as odds ratios (OR) with 95% confidence intervals (CIs) using the Mantel-Haenszel method. A multi-treatment comparison was performed, examining the risk reduction associated with existing bariatric surgery techniques. Analysis was performed using RevMan, R packages, and Shiny. RESULTS Data from 11 registries including 6,214,682 patients with obesity were analyzed. Of these, 14.0% underwent bariatric surgery (872,499/6,214,682), and 86.0% did not undergo surgery (5,432,183/6,214,682). The mean age was 49.8 years, and mean follow-up was 5.1 years. In total, 0.6% of patients who underwent bariatric surgery developed CRC (4,843/872,499), as did 1.0% of unoperated patients with obesity (54,721/5,432,183). Patients with obesity who underwent bariatric surgery were less likely to develop CRC (OR: 0.53, 95% CI: 0.36-0.77, P < 0.001, I2 = 99%). Patients with obesity undergoing gastric bypass surgery (GB) (OR: 0.513, 95% CI: 0.336-0.818) and sleeve gastrectomy (SG) (OR: 0.484, 95% CI: 0.307-0.763) were less likely to develop CRC than unoperated patients. CONCLUSION At a population level, bariatric surgery is associated with reduced CRC risk in patients with obesity. GB and SG are associated with the most significant reduction in CRC risk. PROSPERO REGISTRATION CRD42022313280.
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Affiliation(s)
- Matthew G Davey
- Discipline of Surgery, The Lambe Institute for Translational Research, University of Galway, Galway, H91YR71, Ireland.
| | - Odhrán K Ryan
- Surgical Professorial Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland
| | - Éanna J Ryan
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Noel E Donlon
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Ian S Reynolds
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Naomi M Fearon
- Surgical Professorial Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland
| | - Sean T Martin
- Surgical Professorial Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland
| | - Helen M Heneghan
- Surgical Professorial Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland
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Wilson R, Aminian A. Obesity-associated cancer risk reduction after metabolic surgery: insights from the SPLENDID study and the path forward. Surg Obes Relat Dis 2023; 19:788-793. [PMID: 36948974 DOI: 10.1016/j.soard.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/09/2023]
Abstract
Obesity incidence continues to rise globally along with obesity-associated conditions, which heavily burden individuals' quality of life and healthcare systems. Evidence regarding the power of metabolic and bariatric surgery to treat obesity has, fortunately, brought to light how substantial and sustained weight loss can mitigate adverse clinical outcomes of obesity and metabolic disease. Obesity-associated cancer has been an important focus of studies in recent decades to further elucidate what impact metabolic surgery could have on incidence of cancer and cancer-related mortality. The SPLENDID (Surgical Procedures and Long-term Effectiveness in Neoplastic Disease Incidence and Death) study is one of the recent large cohort studies that highlights the power of substantial weight loss and the long-term benefits to patients with obesity in preventing cancer. This review of SPLENDID aims to highlight both consistency of results with prior studies and new findings unexplored previously.
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Affiliation(s)
- Rickesha Wilson
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
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25
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Kuziel G, Moore BN, Arendt LM. Obesity and Fibrosis: Setting the Stage for Breast Cancer. Cancers (Basel) 2023; 15:cancers15112929. [PMID: 37296891 DOI: 10.3390/cancers15112929] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Obesity is a rising health concern and is linked to a worsened breast cancer prognosis. Tumor desmoplasia, which is characterized by elevated numbers of cancer-associated fibroblasts and the deposition of fibrillar collagens within the stroma, may contribute to the aggressive clinical behavior of breast cancer in obesity. A major component of the breast is adipose tissue, and fibrotic changes in adipose tissue due to obesity may contribute to breast cancer development and the biology of the resulting tumors. Adipose tissue fibrosis is a consequence of obesity that has multiple sources. Adipocytes and adipose-derived stromal cells secrete extracellular matrix composed of collagen family members and matricellular proteins that are altered by obesity. Adipose tissue also becomes a site of chronic, macrophage-driven inflammation. Macrophages exist as a diverse population within obese adipose tissue and mediate the development of fibrosis through the secretion of growth factors and matricellular proteins and interactions with other stromal cells. While weight loss is recommended to resolve obesity, the long-term effects of weight loss on adipose tissue fibrosis and inflammation within breast tissue are less clear. Increased fibrosis within breast tissue may increase the risk for tumor development as well as promote characteristics associated with tumor aggressiveness.
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Affiliation(s)
- Genevra Kuziel
- Cancer Biology Graduate Program, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705, USA
| | - Brittney N Moore
- Department of Comparative Biosciences, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA
| | - Lisa M Arendt
- Cancer Biology Graduate Program, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705, USA
- Department of Comparative Biosciences, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA
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26
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Bustamante-Lopez L, Sulbaran M, Changoor NR, Tilahun Y, Garcia-Henriquez N, Albert M, Soliman M, Monson JRT, Pepe J. Impact of bariatric surgery on early-onset colorectal cancer risk: a systematic review and meta-analysis. Updates Surg 2023:10.1007/s13304-023-01527-2. [PMID: 37178403 DOI: 10.1007/s13304-023-01527-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
The aim of this meta-analysis is to determine the impact of bariatric surgery on the risk of early-onset colorectal neoplasia. This systematic review was conducted according to PRISMA recommendations. It was registered in the PROSPERO international database. A comprehensive search was conducted in electronic databases (MEDLINE, EMBASE, and Web of Science) for completed studies until May 2022. The Search was made using a mixture of indexed terms and title, abstract and keywords. The search included terms: obese, surgical weight loss intervention, colorectal cancer, and colorectal adenomas. Studies that included bariatric intervention patient's vs non-surgical obese patients younger than 50 years were considered. Inclusion criteria were patients with BMI more than 35 kg/m2 who underwent a colonoscopy. Studies with follow-up colonoscopy performed in less than 4 years after bariatric surgery and those that evaluated patients with a mean age difference of 5 or more years between groups were excluded. Outcomes analyzed in obese patients with surgical treatment vs control patients included colorectal cancer incidence. From 2008 to 2021, a total of 1536 records were identified. Five retrospective studies that included 48,916 patients were analyzed. Follow-up period ranged from 5 to 22.2 years. 20,663 (42.24%) patients underwent bariatric surgery and 28,253 (57.76%) were part of the control patients. Roux-en-Y gastric bypass was performed in 14,400 (69.7%) individuals. The intervention and control group were similar in age range, proportion of female participants and initial body mass index (35-48.3 vs 35-49.3, respectively). 126/20663 (0.61%) patients in the bariatric surgery group and 175/28253 (0.62%) individuals in the control group presented CRC. In this meta-analysis, we were unable to demonstrate a significant impact of the Bariatric Surgery on EOCRC risk. Prospective trials with longer follow-up periods should be done to prove the colorectal cancer risk reduction.
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Affiliation(s)
- L Bustamante-Lopez
- Surgical Health Outcomes Consortium (SHOC), Adventhealth Medical Group Colorectal Surgery, 2415 North Orange Av. Office 102., AdventHealth, Orlando, FL, USA.
| | - M Sulbaran
- Surgical Health Outcomes Consortium (SHOC), Adventhealth Medical Group Colorectal Surgery, 2415 North Orange Av. Office 102., AdventHealth, Orlando, FL, USA
- Mayo Clinic, Division of Gastroenterology and Hepatology, Jacksonville, FL, USA
| | - N R Changoor
- Surgical Health Outcomes Consortium (SHOC), Adventhealth Medical Group Colorectal Surgery, 2415 North Orange Av. Office 102., AdventHealth, Orlando, FL, USA
| | - Y Tilahun
- Surgical Health Outcomes Consortium (SHOC), Adventhealth Medical Group Colorectal Surgery, 2415 North Orange Av. Office 102., AdventHealth, Orlando, FL, USA
| | - N Garcia-Henriquez
- Surgical Health Outcomes Consortium (SHOC), Adventhealth Medical Group Colorectal Surgery, 2415 North Orange Av. Office 102., AdventHealth, Orlando, FL, USA
| | - M Albert
- Surgical Health Outcomes Consortium (SHOC), Adventhealth Medical Group Colorectal Surgery, 2415 North Orange Av. Office 102., AdventHealth, Orlando, FL, USA
| | - M Soliman
- Surgical Health Outcomes Consortium (SHOC), Adventhealth Medical Group Colorectal Surgery, 2415 North Orange Av. Office 102., AdventHealth, Orlando, FL, USA
| | - J R T Monson
- Surgical Health Outcomes Consortium (SHOC), Adventhealth Medical Group Colorectal Surgery, 2415 North Orange Av. Office 102., AdventHealth, Orlando, FL, USA
| | - Julie Pepe
- Surgical Health Outcomes Consortium (SHOC), Adventhealth Medical Group Colorectal Surgery, 2415 North Orange Av. Office 102., AdventHealth, Orlando, FL, USA
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Hussan H, Ali MR, Hussain SK, Lyo V, McLaughlin E, Chiang C, Thompson HJ. The impact of surgical weight loss procedures on the risk of metachronous colorectal neoplasia: the differential effect of surgery type, sex, and anatomic location. J Natl Cancer Inst Monogr 2023; 2023:77-83. [PMID: 37139983 PMCID: PMC10157775 DOI: 10.1093/jncimonographs/lgac029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 05/05/2023] Open
Abstract
Patients with prior colorectal polyps are at high risk for metachronous colorectal neoplasia, especially in the presence of obesity. We assessed the impact of 2 common bariatric surgeries, vertical sleeve gastrectomy and roux-n-Y gastric bypass, on the risk of colorectal neoplasia recurrence. This nationally representative analysis included 1183 postbariatric adults and 3193 propensity score-matched controls, who all had prior colonoscopy with polyps and polypectomy. Colorectal polyps reoccurred in 63.8% of bariatric surgery patients and 71.7% of controls at a mean follow-up of 53.1 months from prior colonoscopy. There was a reduced odds of colorectal polyp recurrence after bariatric surgery compared with controls (odds ratio [OR] = 0.70, 95% confidence interval [CI] = 0.58 to 0.83). This effect was most pronounced in men (OR = 0.58, 95% CI = 0.42 to 0.79), and post roux-n-Y gastric bypass (OR = 0.57, 95% CI = 0.41 to 0.79). However, the risk of rectal polyps or colorectal cancer remained consistent between groups. This study is the first to our knowledge to show a reduction in risk of polyp recurrence following bariatric surgery.
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Affiliation(s)
- Hisham Hussan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California Davis, Sacramento, CA, USA
| | - Mohamed R Ali
- Division of Foregut, Metabolic, General Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Shehnaz K Hussain
- Department of Public Health Sciences, School of Medicine and Comprehensive Cancer Center, University of California, Davis, Davis, CA, USA
| | - Victoria Lyo
- Division of Foregut, Metabolic, General Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Eric McLaughlin
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - ChienWei Chiang
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Henry J Thompson
- Cancer Prevention Laboratory, Colorado State University, Fort Collins, CO, USA
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Janik MR, Clapp B, Sroczyński P, Ghanem O. The effect of bariatric surgery on reducing the risk of colorectal cancer: a meta-analysis of 3,233,044 patients. Surg Obes Relat Dis 2023; 19:328-334. [PMID: 36446716 DOI: 10.1016/j.soard.2022.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The published literature presents conflicting results regarding the impact of bariatric surgery on the incidence of colorectal cancer. There are important new studies that have addressed this question with longer follow-up. OBJECTIVE To investigate the effect of bariatric surgery on the risk of developing colorectal cancer in patients with obesity. SETTING Meta-analysis. METHODS PubMed and Scopus were searched for relevant articles. Articles published by November 2021 were retrieved; data were extracted according to the evidence-based PICO (population, intervention, control, outcome) model and analyzed using a random-effects model to estimate the pooled relative risk (RR) and its 95% confidence interval. The heterogeneity of studies was tested and quantified using Cochran's Q. RESULTS The initial search yielded 327 articles. After evaluation, 13 studies were analyzed. The thorough evaluation resulted in 13 articles, which were analyzed. A total number of 3,233,044 patients were included in the meta-analysis. The mean time of follow-up was 9.5 ± 7.9 years. The pooled estimate of the adjusted RR was .63 (95% confidence interval, .50-.79). Heterogeneity χ2 was 107.96 (df = 12; P < .001; I2 = 89%). CONCLUSION Patients who underwent bariatric surgery had a 37% reduction in the risk of developing colorectal cancer compared with patients with obesity who had no surgery.
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Affiliation(s)
- Michał R Janik
- Department of Surgery, Military Institute of Aviation Medicine, Warsaw, Poland.
| | - Benjamin Clapp
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, Texas
| | | | - Omar Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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Wilson RB, Lathigara D, Kaushal D. Systematic Review and Meta-Analysis of the Impact of Bariatric Surgery on Future Cancer Risk. Int J Mol Sci 2023; 24:ijms24076192. [PMID: 37047163 PMCID: PMC10094585 DOI: 10.3390/ijms24076192] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
The study aimed to perform a systematic review and meta-analysis of the evidence for the prevention of future cancers following bariatric surgery. A systematic literature search of the Cochrane Library, Embase, Scopus, Web of Science and PubMed databases (2007–2023), Google Scholar and grey literature was conducted. A meta-analysis was performed using the inverse variance method and random effects model. Thirty-two studies involving patients with obesity who received bariatric surgery and control patients who were managed with conventional treatment were included. The meta-analysis suggested bariatric surgery was associated with a reduced overall incidence of cancer (RR 0.62, 95% CI 0.46–0.84, p < 0.002), obesity-related cancer (RR 0.59, 95% CI 0.39–0.90, p = 0.01) and cancer-associated mortality (RR 0.51, 95% CI 0.42–0.62, p < 0.00001). In specific cancers, bariatric surgery was associated with reduction in the future incidence of hepatocellular carcinoma (RR 0.35, 95% CI 0.22–0.55, p < 0.00001), colorectal cancer (RR 0.63, CI 0.50–0.81, p = 0.0002), pancreatic cancer (RR 0.52, 95% CI 0.29–0.93, p = 0.03) and gallbladder cancer (RR 0.41, 95% CI 0.18–0.96, p = 0.04), as well as female specific cancers, including breast cancer (RR 0.56, 95% CI 0.44–0.71, p < 0.00001), endometrial cancer (RR 0.38, 95% CI 0.26–0.55, p < 0.00001) and ovarian cancer (RR 0.45, 95% CI 0.31–0.64, p < 0.0001). There was no significant reduction in the incidence of oesophageal, gastric, thyroid, kidney, prostate cancer or multiple myeloma after bariatric surgery as compared to patients with morbid obesity who did not have bariatric surgery. Obesity-associated carcinogenesis is closely related to metabolic syndrome; visceral adipose dysfunction; aromatase activity and detrimental cytokine, adipokine and exosomal miRNA release. Bariatric surgery results in long-term weight loss in morbidly obese patients and improves metabolic syndrome. Bariatric surgery may decrease future overall cancer incidence and mortality, including the incidence of seven obesity-related cancers.
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Li J, Yang H, Zhang L, Zhang S, Dai Y. Metabolic reprogramming and interventions in endometrial carcinoma. Biomed Pharmacother 2023; 161:114526. [PMID: 36933381 DOI: 10.1016/j.biopha.2023.114526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Cancer cells are usually featured by metabolic adaptations that facilitate their growth, invasion, and metastasis. Thus, reprogramming of intracellular energy metabolism is currently one of the hotspots in the field of cancer research. Whereas aerobic glycolysis (known as the Warburg effect) has long been considered a dominant form of energy metabolism in cancer cells, emerging evidence indicates that other metabolic forms, especially oxidative phosphorylation (OXPHOS), may play a critical role at least in some types of cancer. Of note, women with metabolic syndromes (MetS), including obesity, hyperglycemia, dyslipidemia, and hypertension, have an increased risk of developing endometrial carcinoma (EC), suggesting a close link between metabolism and EC. Interestingly, the metabolic preferences vary among EC cell types, particularly cancer stem cells and chemotherapy-resistant cells. Currently, it is commonly accepted that glycolysis is the main energy provider in EC cells, while OXPHOS is reduced or impaired. Moreover, agents specifically targeting the glycolysis and/or OXPHOS pathways can inhibit tumor cell growth and promote chemosensitization. For example, metformin and weight control not only reduce the incidence of EC but also improve the prognosis of EC patients. In this review, we comprehensively overview the current in-depth understanding of the relationship between metabolism and EC and provide up-to-date insights into the development of novel therapies targeting energy metabolism for auxiliary treatment in combination with chemotherapy for EC, especially those resistant to conventional chemotherapy.
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Affiliation(s)
- Jiajia Li
- The Laboratory of Cancer Precision Medicine, the First Hospital of Jilin University, Changchun, Jilin 130061, China; Department of Gynecologic Oncology, Gynecology and Obstetrics Center, the First Hospital of Jilin University, Changchun, Jilin 130012, China
| | - Hongmei Yang
- Department of Critical Care Medicine, the First Hospital of Jilin University, Changchun, Jilin 130012, China
| | - Lingyi Zhang
- Department of Gynecology and Obstetrics, the Second Hospital of Jilin University, Changchun, Jilin 130041, China
| | - Songling Zhang
- Department of Gynecologic Oncology, Gynecology and Obstetrics Center, the First Hospital of Jilin University, Changchun, Jilin 130012, China.
| | - Yun Dai
- The Laboratory of Cancer Precision Medicine, the First Hospital of Jilin University, Changchun, Jilin 130061, China.
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Zheng Z, Hu Y, Tang J, Xu W, Zhu W, Zhang W. The implication of gut microbiota in recovery from gastrointestinal surgery. Front Cell Infect Microbiol 2023; 13:1110787. [PMID: 36926517 PMCID: PMC10011459 DOI: 10.3389/fcimb.2023.1110787] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/15/2023] [Indexed: 03/08/2023] Open
Abstract
Recovery from gastrointestinal (GI) surgery is often interrupted by the unpredictable occurrence of postoperative complications, including infections, anastomotic leak, GI dysmotility, malabsorption, cancer development, and cancer recurrence, in which the implication of gut microbiota is beginning to emerge. Gut microbiota can be imbalanced before surgery due to the underlying disease and its treatment. The immediate preparations for GI surgery, including fasting, mechanical bowel cleaning, and antibiotic intervention, disrupt gut microbiota. Surgical removal of GI segments also perturbs gut microbiota due to GI tract reconstruction and epithelial barrier destruction. In return, the altered gut microbiota contributes to the occurrence of postoperative complications. Therefore, understanding how to balance the gut microbiota during the perioperative period is important for surgeons. We aim to overview the current knowledge to investigate the role of gut microbiota in recovery from GI surgery, focusing on the crosstalk between gut microbiota and host in the pathogenesis of postoperative complications. A comprehensive understanding of the postoperative response of the GI tract to the altered gut microbiota provides valuable cues for surgeons to preserve the beneficial functions and suppress the adverse effects of gut microbiota, which will help to enhance recovery from GI surgery.
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Affiliation(s)
| | | | | | | | | | - Wei Zhang
- Department of General Surgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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32
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Pararas N, Pikouli A, Dellaportas D, Nastos C, Charalampopoulos A, Muqresh MA, Bagias G, Pikoulis E, Papaconstantinou D. The Protective Effect of Bariatric Surgery on the Development of Colorectal Cancer: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3981. [PMID: 36900989 PMCID: PMC10001715 DOI: 10.3390/ijerph20053981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Obesity is a known risk factor for developing colorectal cancer (CRC) and is associated with the formation of precancerous colonic adenomas. Bariatric surgery (BRS) is considered to reduce the cancer risk in morbidly obese patients. However, the currently available literature yields contradicting results regarding the impact of bariatric surgery on the incidence of CRC. METHODS A systematic literature search of the Medline, Embase, CENTRAL, CINAHL, Web of Science, and clinicaltrials.gov databases was undertaken following the PRISMA guidelines. A random effects model was selected. RESULTS Twelve retrospective cohort studies, incorporating a total of 6,279,722 patients, were eligible for inclusion in the final quantitative analysis. Eight studies originated from North America, while four reported on European patients. Patients in the Bariatric Surgery group exhibited a significantly reduced risk for developing colorectal cancer (RR 0.56, 95% CI 0.4-0.8, p < 0.001), while sleeve gastrectomy was found to be significantly associated with a smaller incidence of CRC (RR 0.55, 95% CI 0.36-0.83, p < 0.001), and gastric bypass and banding did not. CONCLUSIONS A significant protective effect of BRS against the development of CRC is implied. In the present analysis, the incidence rate of colorectal cancer was approximately halved amongst the obese individuals that were operated on.
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Affiliation(s)
- Nikolaos Pararas
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Anastasia Pikouli
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Dionysios Dellaportas
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Constantinos Nastos
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Anestis Charalampopoulos
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | | | - George Bagias
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Emmanouil Pikoulis
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Dimitrios Papaconstantinou
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, 15772 Athens, Greece
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HUANG J, GUO K, WANG P, WANG C. The correlation between obesity and death of old population in Peking. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2023. [DOI: 10.23736/s0393-3660.22.04879-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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34
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The impact of bariatric surgery on colorectal cancer risk. Surg Obes Relat Dis 2023; 19:144-157. [PMID: 36446717 DOI: 10.1016/j.soard.2022.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/08/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022]
Abstract
Obesity is considered a risk factor for different types of cancer, including colorectal cancer (CRC). Bariatric surgery has been associated with improvements in obesity-related co-morbidities and reductions in overall cancer risk. However, given the contradictory outcomes of several cohort studies, the impact of bariatric surgery on CRC risk appears controversial. Furthermore, measurement of CRC biomarkers following Roux-en-Y gastric bypass (RYGB) has revealed hyperproliferation and increased pro-inflammatory gene expression in the rectal mucosa. The proposed mechanisms leading to increased CRC risk are alterations of the gut microbiota and exposure of the colorectum to high concentrations of bile acids, both of which are caused by RYGB-induced anatomical rearrangements. Studies in animals and humans have highlighted the similarities between RYGB-induced microbial profiles and the gut microbiota documented in CRC. Microbial alterations common to post-RYGB cases and CRC include the enrichment of pro-inflammatory microbes and reduction in butyrate-producing bacteria. Lower concentrations of butyrate following RYGB may also contribute to an increased risk of CRC, given the anti-inflammatory and anticarcinogenic properties of this molecule. Laparoscopic sleeve gastrectomy appears to have a more moderate impact than RYGB; however, relatively few animal and human studies have investigated its effects on CRC risk. Moreover, evidence regarding the impact of anastomosis gastric bypass on one is even more limited. Therefore, further studies are required to establish whether the potential increase in CRC risk is restricted to RYGB or may also be associated with other bariatric procedures.
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35
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Veziant J, Benhalima S, Piessen G, Slim K. Obesity, sleeve gastrectomy and gastro-esophageal reflux disease. J Visc Surg 2023; 160:S47-S54. [PMID: 36725450 DOI: 10.1016/j.jviscsurg.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Sleeve gastrectomy (SG) is the most frequently performed operation for morbid obesity in the world. In spite of its demonstrated efficacy, the Achilles' Heel of this procedure seems to be either pre-existing or de novo gastro-esophageal reflux disease (GERD) with its potential complications such as peptic esophagitis, Barrett's esophagus and, in the long-term, esophageal adenocarcinoma. According to factual literature, it appears clear that Roux-en-Y gastric bypass is the preferred choice in case of pre-existing GERD or hiatal hernia discovered during preoperative workup for bariatric surgery. Nonetheless, certain authors propose performance of SG with an associated antireflux procedure such as Nissen fundoplication. Strict endoscopic surveillance is recommended after bariatric surgery. Revisional surgery (conversion of SG into Roux-en-Y gastric bypass (RYGB)) is the treatment of choice for patients who develop GERD after SG when conservative treatment (modified lifestyle and proton pump inhibitors) has failed. Lastly, with regard to the risk of esophageal adenocarcinoma after SG, large scale studies with adequate follow-up are necessary to come to factual conclusions. In all cases, the management of this conundrum remains a major technical challenge that has to be taken in consideration in future years, especially because of the current expansion of bariatric surgery.
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Affiliation(s)
- J Veziant
- Department of Digestive and Oncological Surgery, CHU of Lille, University of Lille, 59000 Lille, France.
| | - S Benhalima
- Department of Digestive and Oncological Surgery, CHU of Lille, University of Lille, 59000 Lille, France
| | - G Piessen
- Department of Digestive and Oncological Surgery, CHU of Lille, University of Lille, 59000 Lille, France
| | - K Slim
- CHU of Estaing, 63003 Clermont-Ferrand, France; Groupe francophone de réhabilitation améliorée après chirurgie (GRACE), France
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Abstract
Reprogrammed metabolism is a hallmark of colorectal cancer (CRC). CRC cells are geared toward rapid proliferation, requiring nutrients and the removal of cellular waste in nutrient-poor environments. Intestinal stem cells (ISCs), the primary cell of origin for CRCs, must adapt their metabolism along the adenoma-carcinoma sequence to the unique features of their complex microenvironment that include interactions with intestinal epithelial cells, immune cells, stromal cells, commensal microbes, and dietary components. Emerging evidence implicates modifiable risk factors related to the environment, such as diet, as important in CRC pathogenesis. Here, we focus on describing the metabolism of ISCs, diets that influence CRC initiation, CRC genetics and metabolism, and the tumor microenvironment. The mechanistic links between environmental factors, metabolic adaptations, and the tumor microenvironment in enhancing or supporting CRC tumorigenesis are becoming better understood. Thus, greater knowledge of CRC metabolism holds promise for improved prevention and treatment.
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Affiliation(s)
- Joseph C Sedlak
- The David H. Koch Institute for Integrative Cancer Research at MIT, Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA;
- Harvard/MIT MD-PhD Program, Harvard Medical School, Boston, Massachusetts, USA
| | - Ömer H Yilmaz
- The David H. Koch Institute for Integrative Cancer Research at MIT, Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA;
- Massachusetts General Hospital, Department of Pathology, Boston, Massachusetts, USA
| | - Jatin Roper
- Division of Gastroenterology, Department of Medicine, Duke University, Durham, North Carolina, USA;
- Department of Pharmacology and Cancer Biology, Duke University, Durham, North Carolina, USA
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Chierici A, Amoretti P, Drai C, De Fatico S, Barriere J, Schiavo L, Iannelli A. Does Bariatric Surgery Reduce the Risk of Colorectal Cancer in Individuals with Morbid Obesity? A Systematic Review and Meta-Analysis. Nutrients 2023; 15:467. [PMID: 36678338 PMCID: PMC9860730 DOI: 10.3390/nu15020467] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
Bariatric surgery has shown to be effective in producing sustained weight loss and the resolution of obesity related medical problems. Recent research focused on the role of obesity and adipose tissue in tumorigenesis, finding a strong crosslink through different mechanisms and highlighting an increase in cancer incidence in individuals with obesity. The aim of this meta-analysis is to find if bariatric surgery reduces the incidence of colorectal cancer in patients with obesity. We performed a meta-analysis including 18 studies (PROSPERO ID: CRD4202235931). Bariatric surgery was found to be significantly protective toward colorectal cancer incidence in individuals with obesity (HR: 0.81, p = 0.0142). The protective effect persisted when considering women (RR: 0.54, p = 0.0014) and men (RR: 0.74, p = 0.2798) separately, although this was not significant for the latter. No difference was found when comparing Roux-en-Y gastric bypass and sleeve gastrectomy. Bariatric surgery reduces the incidence of colorectal cancer in individuals with obesity independently from gender and surgical procedure. Prospective large cohort studies are needed to confirm these findings.
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Affiliation(s)
- Andrea Chierici
- Centre Hospitalier Universitaire de Nice—Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, CEDEX 3, 06200 Nice, France
| | - Paolo Amoretti
- Centre Hospitalier Universitaire de Nice—Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, CEDEX 3, 06200 Nice, France
| | - Céline Drai
- Centre Hospitalier Universitaire de Nice—Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, CEDEX 3, 06200 Nice, France
- Faculté de Medicine, Université Côte d’Azur, 06000 Nice, France
| | - Serena De Fatico
- Centre Hospitalier Universitaire de Nice—Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, CEDEX 3, 06200 Nice, France
| | - Jérôme Barriere
- Medical Oncology Departement, Polyclinique Saint-Jean, 06800 Cagnes-sur-Mer, France
| | - Luigi Schiavo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Antonio Iannelli
- Centre Hospitalier Universitaire de Nice—Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, CEDEX 3, 06200 Nice, France
- Faculté de Medicine, Université Côte d’Azur, 06000 Nice, France
- Inserm, U1065, Team 8 “Hepatic Complications of Obesity and Alcohol”, 06204 Nice, France
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Clapp B, Portela R, Sharma I, Nakanishi H, Marrero K, Schauer P, Halfdanarson TR, Abu Dayyeh B, Kendrick M, Ghanem OM. Risk of non-hormonal cancer after bariatric surgery: meta-analysis of retrospective observational studies. Br J Surg 2022; 110:24-33. [PMID: 36259310 DOI: 10.1093/bjs/znac343] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/18/2022] [Accepted: 09/20/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Obesity is associated with an increased incidence of at least 13 types of cancer. Although bariatric surgery has been associated with a reduced risk of hormonal cancers, data for non-hormonal cancers are scarce. The aim of this study was to evaluate the effect of bariatric surgery on the incidence of non-hormonal cancers. METHODS Cochrane, Embase, PubMed, Scopus, and Web of Science were searched for articles between 1984 and 2018, following the PRISMA system. Meta-analysis was conducted using a random-effect model with subgroup analysis by procedure and cancer type. RESULTS From 2526 studies screened, 15 were included. There were a total of 18 583 477 patients, 947 787 in the bariatric group and 17 635 690 in the control group. In comparison to the non-surgical group, the bariatric group had a lower incidence of cancer (OR .65 (95 per cent c.i. 0.53 to 0.80); P < 0.002). In the subgroup analysis, Roux-en-Y gastric bypass and sleeve gastrectomy were associated with decreased risk of developing cancer, while no difference was observed with adjustable gastric banding. When evaluated by cancer type, liver (OR 0.417 (95 per cent c.i. 0.323 to 0.538)), colorectal (OR 0.64 (95 per cent c.i. 0.49 to 0.84)), kidney and urinary tract cancer (OR 0.77 (95 per cent c.i. 0.72 to 0.83)), oesophageal (OR 0.60 (95 per cent c.i. 0.43 to 0.85)), and lung cancer (OR 0.796 (95 per cent c.i. 0.45 to 0.80)) also presented a lower cancer incidence in the bariatric group. CONCLUSION Bariatric surgery is related to an almost 50 per cent reduction in the risk of non-hormonal cancers.
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Affiliation(s)
- Benjamin Clapp
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, Texas, USA
| | - Ray Portela
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ishna Sharma
- Department of Surgery, University of Connecticut, Farmington, Connecticut, USA
| | | | - Katie Marrero
- Department of Surgery, Carle Foundation Hospital General Surgery Residency, Champaign, Illinois, USA
| | - Philip Schauer
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | | | - Barham Abu Dayyeh
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Gu YJ, Chen LM, Gu ME, Xu HX, Li J, Wu LY. Body mass index-based predictions and personalized clinical strategies for colorectal cancer in the context of PPPM. EPMA J 2022; 13:615-632. [PMID: 36505896 PMCID: PMC9727065 DOI: 10.1007/s13167-022-00306-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/07/2022] [Indexed: 12/03/2022]
Abstract
Currently colorectal cancer (CRC) is the third most prevalent cancer worldwide. Body mass index (BMI) is frequently used in CRC screening and risk assessment to quantitatively evaluate weight. However, the impact of BMI on clinical strategies for CRC has received little attention. Within the framework of the predictive, preventive, and personalized medicine (3PM/PPPM), we hypothesized that BMI stratification would affect the primary, secondary, and tertiary care options for CRC and we conducted a critical evidence-based review. BMI dynamically influences CRC outcomes, which helps avoiding adverse treatment effects. The outcome of surgical and radiation treatment is adversely affected by overweight (BMI ≥ 30) or underweight (BMI < 20). A number of interventions, such as enhanced recovery after surgery and robotic surgery, can be applied to CRC at all levels of BMI. BMI-controlling modalities such as exercise, diet control, nutritional therapy, and medications may be potentially beneficial for patients with CRC. Patients with overweight are advised to lose weight through diet, medication, and physical activity while patients suffering of underweight require more focus on nutrition. BMI assists patients with CRC in better managing their weight, which decreases the incidence of adverse prognostic events during treatment. BMI is accessible, noninvasive, and highly predictive of clinical outcomes in CRC. The cost-benefit of the PPPM paradigm in developing countries can be advanced, and the clinical benefit for patients can be improved with the promotion of BMI-based clinical strategy models for CRC.
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Affiliation(s)
- Yun-Jia Gu
- grid.412540.60000 0001 2372 7462Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437 China ,grid.412540.60000 0001 2372 7462Shanghai Qigong Research Institute, Shanghai University of Traditional Chinese Medicine, No. 650 South Wanping Road, Shanghai, 200030 China
| | - Li-Ming Chen
- grid.412540.60000 0001 2372 7462Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437 China
| | - Mu-En Gu
- grid.412540.60000 0001 2372 7462Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437 China
| | - Hong-Xiao Xu
- grid.412540.60000 0001 2372 7462Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437 China
| | - Jing Li
- grid.412540.60000 0001 2372 7462Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437 China
| | - Lu-Yi Wu
- grid.412540.60000 0001 2372 7462Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No.110 Ganhe Road, Shanghai, 200437 China
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40
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Hasenberg T, König B. [Obesity from the Perspective of Surgical Oncology]. Zentralbl Chir 2022; 147:574-583. [PMID: 36479653 DOI: 10.1055/a-1957-5622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Up to 40% of all adults worldwide are overweight or obese. Besides the established obesity-related comorbidities, such as type 2 diabetes mellitus, hypertension or NAFLD (non-alcoholic fatty liver disease), the focus of interest is shifting towards the influence of increased body weight as a risk factor for the development of malignant diseases. For more than 20 different types of malignancies, interactions between increased body weight and cancer risk have been established. Pathophysiological influences of obesity on carcinogenesis are diverse, including factors such as chronic inflammation, hyperinsulinaemia and insulin resistance, various changes in growth factor and changes in sex hormones. In cohorts of visceral oncology patients, malignancies such as colorectal carcinomas, hepatocellular carcinomas, adenocarcinomas of the pancreas, oesophageal and gastric carcinomas are also linked to an increased disease risk with increasing body weight. Since obesity must be considered a preventable or at least treatable cause of cancer, this review examines the influence of obesity in the field of visceral oncology, examining the effects of obesity on tumour prevalence, prevention and diagnostic testing, as well as its influence on treatment and prognosis. Furthermore, this review explores the current evidence on the influence of bariatric surgery on the prevalence of these obesity associated tumours. For example, in the case of colorectal carcinomas, the evidence base following bariatric surgery is mixed, painting an inhomogeneous picture. On the other hand, significantly lower prevalence of pancreatic adenocarcinoma and hepatocellular carcinomas is to be noted. The latter effect can be explained by the decrease in non-alcoholic fatty liver disease (NAFLD) associated with weight loss. Despite the justified concern that bariatric procedures (especially gastric sleeve resection) lead to increased prevalence of malignancies of the oesophageal junction, the currently available epidemiological data does not seem to identify a relevant increase in the incidence of these malignancies.
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Affiliation(s)
- Till Hasenberg
- Helios Adipositas Zentrum West, HELIOS Sankt Elisabeth Klinik Oberhausen, Oberhausen, Deutschland
| | - Barbara König
- Helios Adipositas Zentrum West, HELIOS Sankt Elisabeth Klinik Oberhausen, Oberhausen, Deutschland
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41
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Meijer JL, Roderka MN, Chinburg EL, Renier TJ, McClure AC, Rothstein RI, Barry EL, Billmeier S, Gilbert-Diamond D. Alterations in Fecal Short-Chain Fatty Acids after Bariatric Surgery: Relationship with Dietary Intake and Weight Loss. Nutrients 2022; 14:nu14204243. [PMID: 36296927 PMCID: PMC9607039 DOI: 10.3390/nu14204243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 11/28/2022] Open
Abstract
Bariatric surgery is associated with weight loss attributed to reduced caloric intake, mechanical changes, and alterations in gut hormones. However, some studies have suggested a heightened incidence of colorectal cancer (CRC) has been associated with bariatric surgery, emphasizing the importance of identifying mechanisms of risk. The objective of this study was to determine if bariatric surgery is associated with decreases in fecal short-chain fatty acids (SCFA), a group of bacterial metabolites of fiber. Fecal samples (n = 22) were collected pre- (~6 weeks) and post-bariatric surgery (~4 months) in patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy. SCFA levels were quantified using liquid chromatography/mass spectrometry. Dietary intake was quantified using 24-h dietary recalls. Using an aggregate variable, straight SCFAs significantly decreased by 27% from pre- to post-surgery, specifically acetate, propionate, butyrate, and valerate. Pre-surgery weight was inversely associated with butyrate, with no association remaining post-surgery. Multiple food groups were positively (sugars, milk, and red and orange vegetables) and inversely (animal protein) associated with SCFA levels. Our results suggest a potential mechanism linking dietary intake and SCFA levels with CRC risk post-bariatric surgery with implications for interventions to increase SCFA levels.
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Affiliation(s)
- Jennifer L. Meijer
- Weight and Wellness Center, Dartmouth-Health, Lebanon, NH 03756, USA
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
- Correspondence: ; Tel.: +1-603-650-5250
| | | | - Elsa L. Chinburg
- Weight and Wellness Center, Dartmouth-Health, Lebanon, NH 03756, USA
| | - Timothy J. Renier
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Auden C. McClure
- Weight and Wellness Center, Dartmouth-Health, Lebanon, NH 03756, USA
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Richard I. Rothstein
- Weight and Wellness Center, Dartmouth-Health, Lebanon, NH 03756, USA
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Elizabeth L. Barry
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Sarah Billmeier
- Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Diane Gilbert-Diamond
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
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Abdul Wahab R, le Roux CW. A review on the beneficial effects of bariatric surgery in the management of obesity. Expert Rev Endocrinol Metab 2022; 17:435-446. [PMID: 35949186 DOI: 10.1080/17446651.2022.2110865] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/03/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Obesity is a chronic disease with a complex interplay of multiple factors such as genetic, metabolic, behavioral, and environmental factors. The management of obesity includes; lifestyle modification, psychological therapy, pharmacological therapy, and bariatric surgery. To date, bariatric surgery is the most effective treatment for obesity by offering a long-term reduction in weight, remission of obesity-related complications, and improving quality of life. However, bariatric surgery is not equally effective in all patients. Thus, if we can predict who would benefit most, it will improve the risk versus benefit ratio of having surgery. AREAS COVERED In this narrative review, we explore the question on who will benefit the most from bariatric surgery by examining the recent evidence in the literature. In addition, we investigate the predisposing predictors of bariatric surgery response. Finally, we offer the best strategies in the clinic to explain the potential benefits of bariatric surgery to patients. EXPERT OPINION Bariatric surgery is an effective obesity management approach. Despite its efficacy, considerable variation of individual response exists. Thus, it is important to recognize patients that will benefit most, but at present very few predictors are available which can be clinically useful.
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Affiliation(s)
- Roshaida Abdul Wahab
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Belfied, Ireland
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Belfied, Ireland
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Lazarus E, Bays HE. Cancer and Obesity: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS 2022; 3:100026. [PMID: 37990728 PMCID: PMC10661911 DOI: 10.1016/j.obpill.2022.100026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) provides an overview of cancer and increased body fat. Methods The scientific information for this CPS is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results Topics include the increased risk of cancers among patients with obesity, cancer risk factor population-attributable fractions, genetic and epigenetic links between obesity and cancer, adiposopathic and mechanistic processes accounting for increased cancer risk among patients with obesity, the role of oxidative stress, and obesity-related cancers based upon Mendelian randomization and observational studies. Other topics include nutritional and physical activity principles for patients with obesity who either have cancer or are at risk for cancer, and preventive care as it relates to cancer and obesity. Conclusions Obesity is the second most common preventable cause of cancer and may be the most common preventable cause of cancer among nonsmokers. This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on cancer is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Patients with obesity are at greater risk of developing certain types of cancers, and treatment of obesity may influence the risk, onset, progression, and recurrence of cancer in patients with obesity.
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Affiliation(s)
- Ethan Lazarus
- Diplomate American Board of Obesity Medicine, Diplomate American Board of Family Medicine, President Obesity Medicine Association (2021- 2022); Delegate American Medical Association, Clinical Nutrition Center 5995 Greenwood Plaza Blvd, Ste 150, Greenwood Village, CO 80111
| | - Harold Edward Bays
- Diplomate of American Board of Obesity Medicine, Medical Director/President Louisville Metabolic and Atherosclerosis Research Center, Clinical Associate Professor/University of Louisville Medical School, 3288 Illinois Avenue, Louisville, KY, 40213, USA
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44
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Ross RC, Akinde YM, Schauer PR, le Roux CW, Brennan D, Jernigan AM, Bueter M, Albaugh VL. The role of bariatric and metabolic surgery in the development, diagnosis, and treatment of endometrial cancer. Front Surg 2022; 9:943544. [PMID: 36117808 PMCID: PMC9470773 DOI: 10.3389/fsurg.2022.943544] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/25/2022] [Indexed: 12/13/2022] Open
Abstract
The obesity pandemic continues to contribute to a worsening burden of disease worldwide. The link between obesity and diseases such as diabetes, cardiovascular disease, and cancer has been well established, yet most patients living with obesity remain untreated or undertreated. Metabolic and bariatric surgery is the most effective and durable treatment for obesity, is safe, and may have a protective benefit with respect to cancer incidence. In this review, an overview of the link between obesity, metabolic surgery, and cancer is discussed with emphasis on indications for endometrial cancer, the malignancy most strongly associated with obesity. Considerable evidence from retrospective and prospective cohort studies supports a decreased risk of endometrial cancer in patients with obesity who undergo bariatric surgery compared with nonsurgical controls. Survivors of endometrial cancer are at increased risk of poor health outcomes associated with obesity, and women with endometrial cancer are more likely to die of cardiovascular disease and other obesity-related illnesses than of the malignancy itself. Recent advances in anticancer drug therapies have targeted pathways that may also be therapeutically altered with metabolic surgery. Metabolic surgery has significant potential to enter the treatment paradigm for endometrial cancer, and gynecologic oncologist visits present an opportunity to identify patients who may benefit the most.
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Affiliation(s)
- Robert C. Ross
- Translational and Integrative Gastrointestinal and Endocrine Research Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Yetunde M. Akinde
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Philip R. Schauer
- Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Carel W. le Roux
- School of Medicine, St. Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Donal Brennan
- UCD Gynecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Belfield, Dublin, Ireland
| | - Amelia M. Jernigan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Marco Bueter
- Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Zürich, Switzerland
| | - Vance L. Albaugh
- Translational and Integrative Gastrointestinal and Endocrine Research Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
- Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
- Correspondence: Vance L. Albaugh
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45
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Bhardwaj NJ, Chae K, Sheng JY, Yeh HC. Clinical interventions to break the obesity and cancer link: a narrative review. Cancer Metastasis Rev 2022; 41:719-735. [PMID: 35933566 DOI: 10.1007/s10555-022-10055-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
Excess body weight is a significant risk factor for the development and recurrence of many types of cancer. Patients with a history or current diagnosis of cancer who are overweight or have obesity have an increased risk of cancer treatment-related morbidity, recurrence, and decreased quality of life. Weight loss and maintenance of a healthy body weight may reduce cancer morbidity and recurrence in cancer survivors. While guidelines for cancer survivorship elaborate sufficiently on lifestyle interventions, little guidance is provided when considering additional therapies like anti-obesity pharmacotherapy or bariatric surgery for weight loss. This review will highlight and address current recommendations and feasible interventions that clinicians may consider to further reduce the incidence and recurrence of cancer in patients with obesity.
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Affiliation(s)
- Nakul J Bhardwaj
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kacey Chae
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jennifer Y Sheng
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Hsin-Chieh Yeh
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Bardou M, Rouland A, Martel M, Loffroy R, Barkun AN, Chapelle N. Review article: obesity and colorectal cancer. Aliment Pharmacol Ther 2022; 56:407-418. [PMID: 35707910 DOI: 10.1111/apt.17045] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/01/2021] [Accepted: 05/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Obesity is a growing global public health problem. More than half the European and North American population is overweight or obese. Colon and rectum cancers are still the second leading cause of cancer death worldwide, and epidemiological data support an association between obesity and colorectal cancers (CRCs). AIM To review the literature on CRC epidemiology in obese subjects, assessing the effects of obesity, including childhood or maternal obesity, on CRC, diagnosis, management, and prognosis, and discussing targeted prophylactic measures. METHOD We searched PubMed for obesity/overweight/metabolic syndrome and CRC. Other key words included 'staging', 'screening', 'treatment', 'weight loss', 'bariatric surgery' and 'chemotherapy'. RESULTS In Europe, about 11% of CRCs are attributed to overweight and obesity. Epidemiological data suggest that obesity is associated with a 30%-70% increased risk of colon cancer in men, the association being less consistent in women. Visceral fat or abdominal obesity seems to be of greater concern than subcutaneous fat obesity, and any 1 kg/m2 increase in body mass index confers more risk (hazard ratio 1.03). Obesity might increase the likelihood of recurrence or mortality of the primary cancer and may affect initial management, including accurate staging. The risk maybe confounded by different factors, including lower adherence to organised CRC screening programmes. It is unclear whether bariatric surgery helps reduce rectal cancer risk. CONCLUSIONS Despite a growing body of evidence linking obesity to CRC, many questions remain unanswered, including whether we should screen patients with obesity earlier or propose prophylactic bariatric surgery for certain patients with obesity.
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Affiliation(s)
- Marc Bardou
- INSERM-Centre d'Investigations Cliniques 1432 (CIC 1432), CHU Dijon-Bourgogne, Dijon, France.,UFR Sciences Santé, Université de Bourgogne-Franche Comté, Dijon, France
| | - Alexia Rouland
- Endocrinology Department, CHU Dijon-Bourgogne, Dijon, France
| | - Myriam Martel
- Department of Clinical Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | | | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Centre, Montréal, Québec, Canada
| | - Nicolas Chapelle
- Department of Gastroenterology, Digestive Diseases Institute, CHU de Nantes, Nantes, France.,INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN5, Nantes, France
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Chiappetta S, Bottino V, Farina A. Can Bariatric and Metabolic Surgery Prevent Cancer Recurrence in Obesity-Related Neoplasms? Obes Surg 2022; 32:3469-3470. [PMID: 35902541 DOI: 10.1007/s11695-022-06230-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 07/19/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Sonja Chiappetta
- Bariatric and Metabolic Surgery Unit, Department of General Surgery, Ospedale Evangelico Betania, Via Argine 604, 80147, Naples, Italy.
| | - Vincenzo Bottino
- Department of General Surgery, Ospedale Evangelico Betania, Naples, Italy
| | - Amalia Farina
- Breast Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
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Lunger F, Aeschbacher P, Nett PC, Peros G. The impact of bariatric and metabolic surgery on cancer development. Front Surg 2022; 9:918272. [PMID: 35910464 PMCID: PMC9334768 DOI: 10.3389/fsurg.2022.918272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/30/2022] [Indexed: 12/21/2022] Open
Abstract
Obesity (BMI ≥ 30 kg/m2) with related comorbidities such as type 2 diabetes mellitus, cardiovascular disease, sleep apnea syndrome, and fatty liver disease is one of the most common preventable risk factors for cancer development worldwide. They are responsible for at least 40% of all newly diagnosed cancers, including colon, ovarian, uterine, breast, pancreatic, and esophageal cancer. Although various efforts are being made to reduce the incidence of obesity, its prevalence continues to spread in the Western world. Weight loss therapies such as lifestyle change, diets, drug therapies (GLP-1-receptor agonists) as well as bariatric and metabolic surgery are associated with an overall risk reduction of cancer. Therefore, these strategies should always be essential in therapeutical concepts in obese patients. This review discusses pre- and post-interventional aspects of bariatric and metabolic surgery and its potential benefit on cancer development in obese patients.
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Affiliation(s)
- Fabian Lunger
- Department for Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Pauline Aeschbacher
- Department for Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp C. Nett
- Department for Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- Correspondance: Philipp C. Nett
| | - Georgios Peros
- Department of Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland
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49
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Campanile FC. The Quality of Bowel Preparation After Bariatric Surgery: Diverse Effects of Diversion. Dig Dis Sci 2022; 67:2701-2702. [PMID: 34669077 DOI: 10.1007/s10620-021-07278-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 12/09/2022]
Affiliation(s)
- Fabio Cesare Campanile
- Division of General Surgery, ASL Viterbo, San Giovanni Decollato - Andosilla Hospital, 01033, Civita Castellana, Italy.
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50
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Aminian A, Wilson R, Al-Kurd A, Tu C, Milinovich A, Kroh M, Rosenthal RJ, Brethauer SA, Schauer PR, Kattan MW, Brown JC, Berger NA, Abraham J, Nissen SE. Association of Bariatric Surgery With Cancer Risk and Mortality in Adults With Obesity. JAMA 2022; 327:2423-2433. [PMID: 35657620 PMCID: PMC9166218 DOI: 10.1001/jama.2022.9009] [Citation(s) in RCA: 145] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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.
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Affiliation(s)
- Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Rickesha Wilson
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Abbas Al-Kurd
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Chao Tu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alex Milinovich
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Matthew Kroh
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Raul J. Rosenthal
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic Florida, Weston
| | - Stacy A. Brethauer
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus
| | - Philip R. Schauer
- Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge
| | - Michael W. Kattan
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justin C. Brown
- Cancer Metabolism Program, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge
| | - Nathan A. Berger
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Jame Abraham
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Steven E. Nissen
- Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio
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