Metabolic Bariatric Surgery for Cancer Prevention and Risk Reduction in Patients with Obesity: A GRADE-Based International Federation for the Surgery and Other Therapies for Obesity (IFSO) Position Statement.
Amanda Belluzzi, Maurizio De Luca, Antonio Vitiello et al.
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In 30 seconds
This GRADE-based international position statement systematically reviewed evidence on metabolic bariatric surgery (MBS) and cancer incidence in adults with obesity, comparing surgery with non-surgical weight-loss approaches and examining differences between procedures. No randomised trials reported cancer incidence after MBS; 26 studies entered qualitative synthesis, predominantly retrospective matched cohorts. MBS was generally associated with lower incidence of several obesity-related cancers, although certainty was low to very low. Pooled estimates included an endometrial cancer incidence rate ratio of 0.38 (95% CI 0.23-0.61).
Key findings
- Pooled breast cancer incidence was lower after MBS (IRR 0.85, 95% CI 0.80-0.91).
- Pooled endometrial cancer incidence was lower after MBS (IRR 0.38, 95% CI 0.23-0.61).
- Pooled colorectal cancer incidence was lower after MBS (IRR 0.72, 95% CI 0.59-0.88).
- No randomised trials enrolling adults with obesity reported cancer incidence after MBS; evidence certainty was low to very low.
Why it matters
The findings suggest that sustained weight loss after MBS may be associated with reduced incidence of several obesity-related cancers, extending the potential relevance of surgery beyond weight and metabolic outcomes. However, the evidence does not establish that surgery causes these reductions, and the low certainty means cancer prevention should be interpreted as a possible benefit rather than a proven outcome.
What to keep in mind
Evidence was largely from retrospective matched cohorts, with residual selection bias and heterogeneity; certainty was low to very low, and no relevant randomised trials reported cancer incidence.