Esophagogastric cancer after sleeve gastrectomy and roux-en-Y gastric bypass, its prevalence and risk factors: A meta-analysis

Abstract

Abstract Purpose: In light of the increasing prevalence of esophagogastric cancer (EGC), the altered anatomy after bariatric surgery (BS) (mainly laparoscopic sleeve gastrectomy [LSG] and roux-en-Y gastric bypass [RYGB]) presents difficulties in treating these cancers. The article focuses on the risk factors associated with the development of EGC post-LSG and RYGB. Methods: Relevant articles were identified from databases such as SCOPUS, PubMed, and Web of Science (from 2010 to May 2022). From the selected and screened articles, a meta-analysis was performed using different statistical methods by calculating odds ratios, the t-test, and the discrepancies (95% confidence interval), to estimate the incidence of GC. Publication bias was estimated based on Cochrane risk tool and Newcastle–Ottawa Quality Assessment Scale. Results: The study included case reports (26), random control trials (RCT) (2), case series (6), and prospective (2) and retrospective studies (5). The current article also includes one each of epidemiological and medical administrative database studies. The 43 selected articles comprised 807,458 patients with BS, where 57.5% underwent LSG and 42.5% underwent RYGB. The average age and body mass index (BMI) were 48.11 and 43.53 ± 8.97 in the case of LSG, respectively. The average age was 52.77 and BMI was 42.62 ± 9.21 for RYGB. The obtained results suggested that cancer development is at higher risk in LSG among patients with comorbidities, absence of Helicobacter pylori, and delayed diagnosis, irrespective of their smoking habit. The incidence of the tumor or cancer and its severity is higher after LSG with 41.17% in comparison to RYGB 9.52%. A significant variation was observed in the period of cancer diagnosis. A minimum of 2 and 4 months and a maximum of 96 and 252 months variation have been observed for LSG and RYGB, respectively. No publication bias was noticed based on the selected articles. Furthermore, no direct correlation was identified or measured between the development of ECG and LSG/REYGB surgeries from the collected literature. EGC therapy following BS is complex and requires a personalized strategy that carefully balances optimal treatment with anatomical limitations. Conclusions: The risk factors like obesity, comorbidities, smoking, H. pylori infection, tumor stage, and diagnostic tests must be evaluated before BS. Although the current evidence-based practice does not advocate for a routine preoperative endoscopy, we highly advise for a preoperative endoscopic procedures before BS in the presence of the highlighted EGC risk factors.