Does Anti-Reflux Surgery Cut Esophageal Cancer Risk?

TOPLINE:

For patients with Barrett esophagus, anti-reflux surgery may not reduce but rather increase the risk of esophageal cancer compared with anti-reflux medication, a new study suggests.

METHODOLOGY:

• Researchers conducted a population-based study of all 33,939 adult patients with known Barrett esophagus in any of the national patient registries in Denmark (2012–2020), Finland (1987–1996 and 2010–2020), Norway (2008–2020), and Sweden (2006–2020).

• Patients who underwent anti-reflux surgery (fundoplication) were compared with patients who were taking anti-reflux medication and who had not undergone surgery during the 32-year follow-up period.

• The risk of esophageal adenocarcinoma was calculated using multivariable Cox regression analysis adjusted for age, sex, country, calendar year, and comorbidity.

TAKEAWAY:

• Of all the patients, 542 (1.6%) underwent anti-reflux surgery. The sex distribution was similar between groups, but surgery patients were younger, had longer follow-up, and had fewer comorbidities.

• During up to 32 years of follow-up, the overall risk for esophageal adenocarcinoma was not decreased among those who underwent surgery compared to peers who did not but rather increased (adjusted hazard ratio [HR], 1.9; 95% CI, 1.1 – 3.5).

• The HRs did not decrease with longer follow-up but increased over time, from 1.8 within 1 to 4 years to 4.4 after 10 to 32 years’ follow-up.

IN PRACTICE:

“Although it seems logical that anti-reflux surgery would have a better cancer-preventive effect than anti-reflux medication due to the greater reduction in esophageal acid exposure and the ability to prevent all types of carcinogenic gastric content from reaching the esophagus, performing anti-reflux surgery after years of GERD may be too late to enable a cancer-preventative effect,” the authors write.

SOURCE:

The study, with first author Johan Hardvik Åkerström, MD, Karolinska Institutet, Stockholm, Sweden, was published online September 8 in Gastroenterology.

LIMITATIONS:

Data on some potentially confounding factors, such as tobacco use, body mass index, and length of Barrett segment, were not available; these factors may have influenced the choice between surgery and medication. Statistical power was reduced, particularly in the subgroup analyses, owing to the small size of group that underent anti-reflux surgery and the low number of patients who developed esophageal cancer.

DISCLOSURES:

Funding for the study was provided by the Swedish Cancer Society, the Swedish Research Council, and the Stockholm County Council. The authors have disclosed no relevant conflicts of interest.

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