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Increased Risk of Colorectal Cancer After Obesity Surgery

Derogar, Maryam MD*; Hull, Mark A. MD, PhD; Kant, Prashant MD; Östlund, Magdalena MD*; Lu, Yunxia MD, PhD*; Lagergren, Jesper MD, PhD*,‡

doi: 10.1097/SLA.0b013e318288463a
Original Articles

Objective: The purpose was to determine whether obesity surgery is associated with a long-term increased risk of colorectal cancer.

Background: Long-term cancer risk after obesity surgery is not well characterized. Preliminary epidemiological observations and human tissue biomarker studies recently suggested an increased risk of colorectal cancer after obesity surgery.

Methods: A nationwide retrospective register-based cohort study in Sweden was conducted in 1980–2009. The long-term risk of colorectal cancer in patients who underwent obesity surgery, and in an obese no surgery cohort, was compared with that of the age-, sex- and calendar year-matched general background population between 1980 and 2009. Obese individuals were stratified into an obesity surgery cohort and an obese no surgery cohort. The standardized incidence ratio (SIR), with 95% confidence interval (CI), was calculated.

Results: Of 77,111 obese patients, 15,095 constituted the obesity surgery cohort and 62,016 constituted the obese no surgery cohort. In the obesity surgery cohort, we observed 70 patients with colorectal cancer, rendering an overall SIR of 1.60 (95% CI 1.25–2.02). The SIR for colorectal cancer increased with length of time after surgery, with a SIR of 2.00 (95% CI 1.48–2.64) after 10 years or more. In contrast, the overall SIR in the obese no surgery cohort (containing 373 colorectal cancers) was 1.26 (95% CI 1.14–1.40) and remained stable with increasing follow-up time.

Conclusions: Obesity surgery seems to be associated with an increased risk of colorectal cancer over time. These findings would prompt evaluation of colonoscopy surveillance for the increasingly large population who undergo obesity surgery.

This nationwide Swedish cohort study included 15,095 obesity surgery patients and 62,016 obese patients without such surgery. In the surgery cohort, the risk of colorectal cancer increased with longer follow-up, which was not seen in the obese no surgery cohort.

*Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

Leeds Institute of Molecular Medicine, Wellcome Trust Brenner Building, St James's University Hospital, Leeds, United Kingdom

Division of Cancer Studies, King's College London, London, United Kingdom.

Reprints: Jesper Lagergren, MD, PhD, Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, NS 67, Level 2, 171 76 Stockholm, Sweden. E-mail:

Disclosure: Supported by the Swedish Research Council (ID 80749601). The authors declare no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins.