Society for Surgery of the Alimentary Tract
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Stephen Firkins*1, Yazan Abu Omar1, Heesoo Yoo1, Vibhu Chittajallu2, Bailey Flora1, Brian Baggott1, C. Roberto Simons-Linares1
1Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH; 2University Hospitals, Cleveland, OH

Background: Obesity is a known risk factor for cancer, including pancreatic adenocarcinoma (PDAC). Bariatric surgery is the most effective treatment for obesity and metabolic comorbidities but has also been shown to reduce the risk of PDAC before the age of 50 and among patients with diabetes. We aim to characterize the effects of bariatric surgery on pancreatic cancer risk in the U.S. population using a large, population-based database.

Methods: We performed a retrospective cohort analysis utilizing the National Inpatient Sample (NIS) database from October 2015 to December 2020. All adult subjects with a BMI > 40 or BMI >35 with presence of other comorbidities – hypertension (HTN), Diabetes (DM), hyperlipidemia (HLD) and/or obstructive sleep apnea (OSA) – were identified and stratified into those with and without history of bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy). Baseline characteristics and comorbidities among the two groups were compared using chi-squared and Wilcoxon rank-sum tests. We then performed logistic regression analysis to assess the risk of PDAC after adjusting for risk factors, including tobacco use, acute and chronic pancreatitis, diabetes mellitus and various stages of obesity.

Results: Over 19 million subjects were included, 1,656,329 of whom had a history of bariatric surgery. Patients with a history of bariatric surgery had significantly lower rates of hypertension, hyperlipidemia, chronic kidney disease, tobacco use, and acute and chronic pancreatitis (p<0.001), while having higher rates of obstructive sleep apnea (p<0.001). History of bariatric surgery further significantly reduced the risk of PDAC (OR; 95% CI) on both univariable (0.50; 0.44-0.56) and multivariable analysis (0.68; 0.61-0.77) (p<0.001), when adjusted for multiple comorbidities and confounders.

Conclusion: Bariatric surgery independently exhibits a protective effect against PDAC oncogenesis. This is the largest study to date showing the benefits of surgically-assisted weight loss on PDAC risk. With advancements in minimally invasive bariatric procedures, expanded patient eligibility and acceptance of such procedures may serve to further reduce the burden of pancreatic cancer.

Table 1. Baseline characteristics

Table 2. Univariable and multivariable analysis of pancreatic cancer risk

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