Bariatric and metabolic surgery may lower the risk of developing pancreatic cancer in people with obesity especially in those who also have type 2 diabetes, according to a systematic review and meta-analysis by researchers from the Broad Institute of MIT and Harvard Medical School, Boston, MA, the University Sussex Hospitals NHS Foundation Trust, Chichester, UK, and the University of Piraeus, Piraeus, Greece.
Reported in the paper, ‘Metabolic–Bariatric Surgery Reduces Pancreatic Cancer Risk: A Meta-Analysis of Over 3.7 Million Adults, Independent of Type 2 Diabetes Status’, published in the journal Diabetes/Metabolism Research and Reviews, they found that BMS was associated with a 44% reduction in pancreatic cancer risk among individuals with obesity but without type 2 diabetes and a 79% risk reduction in those with both obesity and type 2 diabetes.
"Metabolic and bariatric surgery not only has beneficial effects on obesity and type 2 diabetes but also may play a crucial role in reducing the risk of pancreatic cancer in these individuals," said corresponding author, Dr Angeliki M Angelidi from the Broad Institute of MIT and Harvard. "These findings underscore the need for further research to elucidate the underlying mechanisms and understand the full spectrum of health benefits of metabolic and bariatric surgery beyond weight loss."
The study authors stated that few studies have explored the association between MBS and a reduced risk of pancreatic cancer, while no study has systematically synthesised evidence from original trials and assessed the effects of MBS on pancreatic cancer risk considering the presence of T2D. Therefore, they we conducted a systematic review and meta-analysis to elucidate the impact of MBS on pancreatic cancer risk in individuals with obesity considering T2D status.
The primary outcome was the incidence of pancreatic cancer in participants with obesity and with or without T2D who underwent BMS, compared with those who did not undergo surgery. The secondary outcome was the incidence of pancreatic cancer in participants with obesity and known T2D who underwent surgery vs. those without T2D who underwent surgery.
They identified 12 studies (eleven cohort studies and one RCT) that included 3,711,243 participants. The follow-up period ranged from 22 months to 33 years. The total number of individuals included in the control (non-surgical) and surgical groups was 3,054,481 and 656,762, respectively.
Four studies reported data on pancreatic cancer incidence in individuals with T2D who had undergone MBS. In all three participants in the MBS group and 165 in the control group developed Pancreatic cancer, corresponding to absolute incidences of 0.04% and 0.29%, respectively. The RR for pancreatic cancer was significantly lower in the surgical group than in the control group (RR = 0.21; 95% CI, 0.07–0.57). A favourable effect of surgery was also observed in individuals without T2D who underwent surgery (RR = 0.56; 95% CI, 0.41–0.78).
The pancreatic cancer incidence rates were 0.08% (40 events in 47,949 participants) and 0.15% (669 events in 448,599 participants) in the surgical and control groups, respectively. When all eligible studies were included, regardless of the T2D status of the participants, the pancreatic cancer RR in the overall population was 0.46 (95% CI, 0.30–0.71) with a total of 363 events among 623,327 participants in the surgical group and 7204 events among 2,989,826 participants in the control group. Surgery also showed a favourable trend in the T2D group compared with the non-T2D group. However, no significant association was observed (RR = 0.51; 95% CI, 0.15–1.71).
Three studies reported data on participants who had undergone sleeve gastrectomy (SG) and five studies on participants who had undergone RYGB. The pancreatic cancer incidence in the SG group and control group was 0.06% and 0.31%, respectively, and in the RYGB group versus the control group was 0.09% and 0.31%, respectively. A significant difference was found between the SG and control groups (RR = 0.24; 95% CI, 0.12–0.46 for SG and RR = 0.52; 95% CI, 0.25–1.09 for RYGB). However, a subgroup analysis from three studies showed no significant differences between the two types of MBS procedures (RR = 1.32; 95% CI, 0.92–1.89).
“The present study showed that MBS was significantly associated with a 54% decrease in Pancreatic cancer risk in obese individuals compared with the results in the non-MBS group,” the authors write. “...Interestingly, our study shows that individuals with obesity and T2D may benefit more from MBS than those without T2D. In our subgroup analysis based on the presence or absence of T2D, we found that MBS was associated with a 44% reduction in pancreatic cancer risk among individuals with obesity but without T2D, whereas a 79% risk reduction was observed in participants with both obesity and T2D.”
Although the mechanisms by which surgery reduces the risk of pancreatic cancer are not fully understood, the impact of surgery on obesity and T2D could be a potential explanation for the beneficial effects of MBS in decreasing pancreatic cancer risk.
Other potential mechanisms may involve the restoration of the leptin-to-adiponectin ratio after surgery, molecular alterations in signalling pathways, such as the mTOR pathway and epigenetic changes, including aberrant DNA methylation, they add.
“Our findings suggest that there may be a more pronounced effect of BMS in patients with T2D, highlighting the potential preventive advantages of BMS in this population,” the authors concluded. “However, additional studies designed to elucidate the relationship between BMS and pancreatic cancer within these populations are crucial to further enhance our understanding of the underlying mechanisms and potential effects of the different types of BMS procedures.”
To access this paper, please click here
Comments