Obesity surgery and cancer. What are the unanswered questions?
Obesity has become a global epidemic with a soaring economic encumbrance due
to its related morbidity and mortality. Amongst obesity-related conditions, cancer is
indeed the most redoubtable. Bariatric surgery has been proven to be the most
effective treatment for obesity and its associatedmetabolic and cardiovascular disorders.
However, the understanding of whether and how bariatric surgery determines a
reduction in cancer risk is limited. Obesity-related malignancies primarily include
colorectal and hormone-sensitive (endometrium, breast, prostate) cancers. Additionally,
esophago-gastric tumors are growing to be recognized as a new category mainly
associated with post-bariatric surgery outcomes. In fact, certain types of surgical
procedures have been described to induce the development and subsequent
progression of pre-cancerous esophageal and gastric lesions. This emerging category is
of great concern and further research is required to possibly prevent such risks. Published
data has generated conflicting results. In fact, while overall cancer risk reduction was
reported particularly in women, some authors showed no improvement or even increased
cancer incidence. Although various studies have reported beneficial effects of surgery
on risk of specific cancer development, fundamental insights into the pathogenesis of
obesity-related cancer are indispensable to fully elucidate its mechanisms.