Colorectal Cancer Risk Is Impacted by Sex and Type of Surgery After Bariatric Surgery

Hisham Hussan, Samuel Akinyeye, Maria Mihaylova, Eric McLaughlin, Chien Wei Chiang, Steven K. Clinton, David Lieberman

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Sex differences exist in the associations between obesity and the risk of colorectal cancer (CRC). However, limited data exist on how sex affects CRC risk after bariatric surgery. Materials and Methods: This retrospective cohort study used the 2012–2020 MarketScan database. We employed a propensity-score-matched analysis and precise coding to define CRC in this nationwide US study. Adjusted hazards ratio (HR) assessed CRC risk ≥ 6 months. In a restricted analysis, logistic regression with adjusted odds ratios (OR) examined CRC risk ≥ 3 years. Results: Our sample included 327,734 controls with severe obesity and 88,630 patients with Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (VSG). The odds of cessation of diabetes mellitus medications, a surrogate for diabetes remission, were higher post-surgery vs. controls, especially in RYGB and males. In females, CRC risk decreased post-RYGB compared to controls (HR = 0.40, 95%CI: 0.18–0.87, p = 0.02). However, VSG was not associated with lower CRC risk in females. Paradoxically, in males compared to controls, CRC risk trended toward an almost significant increase, especially after 3 years or more from surgery (OR = 2.18, 95%CI: 0.97–4.89, p = 0.06). Males had a higher risk of CRC, particularly rectosigmoid cancer, than females after bariatric surgery (HR = 2.69, 95% CI: 1.35–5.38, p < 0.001). Furthermore, diabetes remission was not associated with a lower CRC risk post-surgery. Conclusion: Our data suggest an increased risk of CRC in males compared to females after bariatric surgery. Compared to controls, there was a decrease in CRC risk in females’ post-RYGB but not VSG. Mechanistic studies are needed to explain these differences. Graphical abstract: [Figure not available: see fulltext.].

Original languageEnglish (US)
JournalObesity Surgery
DOIs
StateAccepted/In press - 2022

Keywords

  • Bariatric surgery
  • Colorectal cancer
  • Gastric bypass
  • Risk factor
  • Sleeve gastrectomy

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

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