Skip to main content

Advertisement

SpringerLink
Log in

Effects of Bariatric Surgery on Mortality, Cardiovascular Events, and Cancer Outcomes in Obese Patients: Systematic Review and Meta-analysis

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

The long-term effects of bariatric surgery have yet to be established, and a number of important studies have recently emerged. This systematic review aimed to assess the effects of bariatric surgery on all-cause mortality, cardiovascular events, and cancer compared to non-surgical treatment.

Methods

We searched PubMed, EMBASE, and CENTRAL up to July 13, 2015, and included randomized controlled trials (RCTs) and non-randomized controlled studies comparing bariatric surgery versus non-surgical treatment and reporting data on the three defined outcomes at 1 year or longer. We analyzed RCTs and non-randomized controlled studies, respectively.

Results

Eleven RCTs, 4 non-randomized controlled trials, and 17 cohort studies were included. The randomized evidence suggested substantial uncertainty regarding the effects on all-cause mortality (0/382 vs. 1/287; 7 studies), cancer (OR 0.77, 95 % CI 0.22 to 2.71; 4 studies), and cardiovascular events (no data). The pooled adjusted estimates from non-randomized studies suggested that, compared to the control, the surgical group had lower risk of all-cause mortality (OR 0.55, 95 % CI 0.46 to 0.65; 10 studies), cancer (OR 0.74, 95 % CI 0.65 to 0.85; 2 studies), and cardiovascular events (MI: OR 0.71, 95 % CI 0.54 to 0.94; stroke: OR 0.66, 95 % CI 0.49 to 0.89; and their composite: OR 0.67, 95 % CI 0.54 to 0.83; 1 study).

Conclusions

In conclusion, bariatric surgery could reduce all-cause mortality and probably reduce the risk of any type of cancer. The inference was, however, based on studies with limited methodological rigor. Uncertainty remains regarding the effects on cardiovascular events.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Obesity and overweight [Internet]. World Health Organization; 2015. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/.

  2. Laditka SB, Laditka JN. Active life expectancy of Americans with diabetes: risks of heart disease, obesity, and inactivity. Diabetes Res Clin Pract. 2015;107(1):37–45.

    Article  PubMed  Google Scholar 

  3. Obesity: identification, assessment and management of overweight and obesity in children, young people and adults [Internet]. 2014 [cited 2015 May]. Available from: http://www.nice.org.uk/guidance/cg189/resources/guidance-obesity-identification-assessment-and-management-of-overweight-and-obesity-in-children-young-people-and-adults-pdf.

  4. Baillot A, Audet M, Baillargeon JP, Dionne IJ, Valiquette L, Rosa-Fortin MM, et al. Impact of physical activity and fitness in class II and III obese individuals: a systematic review. Obes Rev. 2014;15(9):721–39.

    Article  CAS  PubMed  Google Scholar 

  5. Bariatric surgery for severe obesity [Internet]. National Institute of Health; 2011. Available from: http://www.niddk.nih.gov/health-information/health-topics/weight-control/bariatric-surgery-severe-obesity/Documents/Bariatric_Surgery_508.pdf.

  6. Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Maggard-Gibbons M, Maglione M, Livhits M, Ewing B, Maher AR, Hu J, et al. Bariatric surgery for weight loss and glycemic control in nonmorbidly obese adults with diabetes: a systematic review. JAMA. 2013;309(21):2250–61.

    Article  CAS  PubMed  Google Scholar 

  8. Busetto L, Mirabelli D, Petroni ML, Mazza M, Favretti F, Segato G, et al. Comparative long-term mortality after laparoscopic adjustable gastric banding versus nonsurgical controls. Surg Obes Relat Dis. 2007;3(5):496-502; discussion

  9. Johnson BL, Blackhurst DW, Latham BB, Cull DL, Bour ES, Oliver TL, et al. Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes mellitus. J Am Coll Surg. 2013;216(4):545–56. discussion 56-8.

    Article  PubMed  Google Scholar 

  10. Sjostrom L, Gummesson A, Sjostrom CD, Narbro K, Peltonen M, Wedel H, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol. 2009;10(7):653–62.

    Article  PubMed  Google Scholar 

  11. Adams TD, Davidson LE, Litwin SE, Kolotkin RL, LaMonte MJ, Pendleton RC, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308(11):1122–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Arterburn D, Bogart A, Coleman KJ, Haneuse S, Selby JV, Sherwood NE, et al. Comparative effectiveness of bariatric surgery vs. nonsurgical treatment of type 2 diabetes among severely obese adults. Obes Res Clin Pract. 2013;7(4):e258–68.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151(4):W65–94.

    Article  PubMed  Google Scholar 

  14. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–12.

    Article  CAS  PubMed  Google Scholar 

  15. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. [Internet]. The Cochrane Collaboration; 2011 [cited 2015 July]. Available from: http://handbook.cochrane.org/.

  16. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle Ottawa Scale (NOS) for assessing the quality of non randomised studies in meta analyses [Internet]. University of Ottawa; 2011 [cited July 2015]. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.

  17. Adams TD, Stroup AM, Gress RE, Adams KF, Calle EE, Smith SC, et al. Cancer incidence and mortality after gastric bypass surgery. Obesity (Silver Spring). 2009;17(4):796–802.

    Article  Google Scholar 

  18. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Dixon JB, Schachter LM, O’Brien PE, Jones K, Grima M, Lambert G, et al. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. JAMA. 2012;308(11):1142–9.

    Article  CAS  PubMed  Google Scholar 

  20. Reis LO, Favaro WJ, Barreiro GC, de Oliveira LC, Chaim EA, Fregonesi A, et al. Erectile dysfunction and hormonal imbalance in morbidly obese male is reversed after gastric bypass surgery: a prospective randomized controlled trial. Int J Androl. 2010;33(5):736–44.

    Article  CAS  PubMed  Google Scholar 

  21. Shikora SA, Bergenstal R, Bessler M, Brody F, Foster G, Frank A, et al. Implantable gastric stimulation for the treatment of clinically severe obesity: results of the SHAPE trial. Surg Obes Relat Dis. 2009;5(1):31–7.

    Article  PubMed  Google Scholar 

  22. Ikramuddin S, Billington CJ, Lee WJ, Bantle JP, Thomas AJ, Connett JE, et al. Roux-en-Y gastric bypass for diabetes (the Diabetes Surgery Study): 2-year outcomes of a 5-year, randomised, controlled trial. Lancet Diabetes Endocrinol. 2015;3(6):413–22.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Courcoulas AP, Belle SH, Neiberg RH, Pierson SK, Eagleton JK, Kalarchian MA, et al. Three-year outcomes of bariatric surgery vs lifestyle intervention for type 2 diabetes mellitus treatment: a randomized clinical trial. JAMA Surg. 2015;150(10):931–40.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.

    Article  CAS  PubMed  Google Scholar 

  25. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Brethauer SA, Navaneethan SD, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370(21):2002–13.

    Article  PubMed  Google Scholar 

  26. Ding SA, Simonson DC, Wewalka M, Halperin F, Foster K, Goebel-Fabbri A, et al. Adjustable gastric band surgery or medical management in patients with type 2 diabetes: a randomized clinical trial. J Clin Endocrinol Metab. 2015;100(7):2546–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Dixon JB, O’Brien PE, Playfair J, Chapman L, Schachter LM, Skinner S, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299(3):316–23.

    Article  CAS  PubMed  Google Scholar 

  28. Halperin F, Ding SA, Simonson DC, Panosian J, Goebel-Fabbri A, Wewalka M, et al. Roux-en-Y gastric bypass surgery or lifestyle with intensive medical management in patients with type 2 diabetes: feasibility and 1-year results of a randomized clinical trial. JAMA Surg. 2014;149(7):716–26.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Koehestanie P, de Jonge C, Berends FJ, Janssen IM, Bouvy ND, Greve JW. The effect of the endoscopic duodenal-jejunal bypass liner on obesity and type 2 diabetes mellitus, a multicenter randomized controlled trial. Ann Surg. 2014;260(6):984–92.

    Article  PubMed  Google Scholar 

  30. Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.

    Article  PubMed  Google Scholar 

  31. Sjostrom L, Peltonen M, Jacobson P, Sjostrom CD, Karason K, Wedel H, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65.

    Article  PubMed  Google Scholar 

  32. Hofso D, Nordstrand N, Johnson LK, Karlsen TI, Hager H, Jenssen T, et al. Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention. Eur J Endocrinol. 2010;163(5):735–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Iaconelli A, Panunzi S, De Gaetano A, Manco M, Guidone C, Leccesi L, et al. Effects of bilio-pancreatic diversion on diabetic complications: a 10-year follow-up. Diabetes Care. 2011;34(3):561–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Palikhe G, Gupta R, Behera BN, Sachdeva N, Gangadhar P, Bhansali A. Efficacy of laparoscopic sleeve gastrectomy and intensive medical management in obese patients with type 2 diabetes mellitus. Obes Surg. 2014;24(4):529–35.

    Article  PubMed  Google Scholar 

  35. Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.

    Article  CAS  PubMed  Google Scholar 

  36. Ahmed AT, Warton EM, Schaefer CA, Shen L, McIntyre RS. The effect of bariatric surgery on psychiatric course among patients with bipolar disorder. Bipolar Disord. 2013;15(7):753–63.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Arterburn DE, Olsen MK, Smith VA, Livingston EH, Van Scoyoc L, Yancy Jr WS, et al. Association between bariatric surgery and long-term survival. JAMA. 2015;313(1):62–70.

    Article  CAS  PubMed  Google Scholar 

  38. Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean AP, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240(3):416–23. discussion 23-4.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg. 2004;199(4):543–51.

    Article  PubMed  Google Scholar 

  40. MacDonald Jr KG, Long SD, Swanson MS, Brown BM, Morris P, Dohm GL, et al. The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus. J Gastrointest Surg. 1997;1(3):213–20. discussion 20.

    Article  PubMed  Google Scholar 

  41. Miranda WR, Goel K, Batsis JA, Rodriguez-Escudero JP, Sarr MG, Collazo-Clavell ML, et al. Long-term mortality in patients undergoing bariatric surgery compared to patients managed non-operatively for morbid obesity. Eur Heart J. 2012;33:494.

  42. Peeters A, O’Brien PE, Laurie C, Anderson M, Wolfe R, Flum D, et al. Substantial intentional weight loss and mortality in the severely obese. Ann Surg. 2007;246(6):1028–33.

    Article  PubMed  Google Scholar 

  43. Pimenta GP, Saruwatari RT, Correa MR, Genaro PL, Aguilar-Nascimento JE. Mortality, weight loss and quality of life of patients with morbid obesity: evaluation of the surgical and medical treatment after 2 years. Arq Gastroenterol. 2010;47(3):263–9.

    Article  PubMed  Google Scholar 

  44. Sanchis P, Frances C, Nicolau J, Rivera R, Fortuny R, Julian X, et al. Cardiovascular risk profile in Mediterranean patients submitted to bariatric surgery and intensive lifestyle intervention: impact of both interventions after 1 year of follow-up. Obes Surg. 2015;25(1):97–108.

    Article  PubMed  Google Scholar 

  45. Sowemimo OA, Yood SM, Courtney J, Moore J, Huang M, Ross R, et al. Natural history of morbid obesity without surgical intervention. Surg Obes Relat Dis. 2007;3(1):73–7. discussion 7.

    Article  PubMed  Google Scholar 

  46. Perry CD, Hutter MM, Smith DB, Newhouse JP, McNeil BJ. Survival and changes in comorbidities after bariatric surgery. Ann Surg. 2008;247(1):21–7.

    Article  PubMed  Google Scholar 

  47. Sampalis JS, Sampalis F, Christou N. Impact of bariatric surgery on cardiovascular and musculoskeletal morbidity. Surg Obes Relat Dis. 2006;2(6):587–91.

    Article  PubMed  Google Scholar 

  48. Christou NV, Lieberman M, Sampalis F, Sampalis JS. Bariatric surgery reduces cancer risk in morbidly obese patients. Surg Obes Relat Dis. 2008;4(6):691–5.

    Article  PubMed  Google Scholar 

  49. Derogar M, Hull MA, Kant P, Ostlund M, Lu Y, Lagergren J. Increased risk of colorectal cancer after obesity surgery. Ann Surg. 2013;258(6):983–8.

    Article  PubMed  Google Scholar 

  50. Kwok CS, Pradhan A, Khan MA, Anderson SG, Keavney BD, Myint PK, et al. Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis. Int J Cardiol. 2014;173(1):20–8.

    Article  PubMed  Google Scholar 

  51. Scott JD, Johnson BL, Blackhurst DW, Bour ES. Does bariatric surgery reduce the risk of major cardiovascular events? A retrospective cohort study of morbidly obese surgical patients. Surg Obes Relat Dis. 2013;9(1):32–9.

    Article  PubMed  Google Scholar 

  52. Casagrande DS, Rosa DD, Umpierre D, Sarmento RA, Rodrigues CG, Schaan BD. Incidence of cancer following bariatric surgery: systematic review and meta-analysis. Obes Surg. 2014;24(9):1499–509.

    Article  PubMed  Google Scholar 

  53. Tee MC, Cao Y, Warnock GL, Hu FB, Chavarro JE. Effect of bariatric surgery on oncologic outcomes: a systematic review and meta-analysis. Surg Endosc. 2013;27(12):4449–56.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Yang XW, Li PZ, Zhu LY, Zhu S. Effects of bariatric surgery on incidence of obesity-related cancers: a meta-analysis. Med Sci Monit. 2015;21:1350–7.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Afshar S, Kelly SB, Seymour K, Lara J, Woodcock S, Mathers JC. The effects of bariatric surgery on colorectal cancer risk: systematic review and meta-analysis. Obes Surg. 2014;24(10):1793–9.

    Article  PubMed  Google Scholar 

  56. Upala S, Anawin S. Bariatric surgery and risk of postoperative endometrial cancer: a systematic review and meta-analysis. Surg Obes Relat Dis. 2015;11(4):949–55.

    Article  PubMed  Google Scholar 

  57. McCawley GM, Ferriss JS, Geffel D, Northup CJ, Modesitt SC. Cancer in obese women: potential protective impact of bariatric surgery. J Am Coll Surg. 2009;208(6):1093–8.

    Article  PubMed  Google Scholar 

  58. Ward KK, Roncancio AM, Shah NR, Davis MA, Saenz CC, McHale MT, et al. Bariatric surgery decreases the risk of uterine malignancy. Gynecol Oncol. 2014;133(1):63–6.

    Article  PubMed  Google Scholar 

  59. Spaniolas K, Kasten KR, Brinkley J, Sippey ME, Mozer A, Chapman WH, et al. The changing bariatric surgery landscape in the USA. Obes Surg. 2015;25(8):1544–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China

    Xu Zhou, Jiajie Yu, Ling Li, Youping Li & Xin Sun

  2. Clinical Research and Evaluation Unit, West China Hospital, Sichuan University, Chengdu, China

    Ling Li, Youping Li & Xin Sun

  3. Basel Institute of Clinical Epidemiology & Biostatistics, University Hospital Basel, Hebelstrasse 10, Basel, Switzerland

    Viktoria Luise Gloy & Alain Nordmann

  4. Saint Joseph’s Hospital and McMaster University, Hamilton, ON, Canada

    Maria Tiboni

  5. Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, 44200, Hubei, China

    Xin Sun

Authors
  1. Xu Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jiajie Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ling Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Viktoria Luise Gloy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alain Nordmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Tiboni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Youping Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Xin Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xin Sun.

Ethics declarations

Conflict of Interest

The authors declare that they have no competing interests.

Statement of Ethical Approval

For this type of study, formal consent is not required.

Statement of Informed Consent

For this type of study, informed consent does not apply.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 217 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhou, X., Yu, J., Li, L. et al. Effects of Bariatric Surgery on Mortality, Cardiovascular Events, and Cancer Outcomes in Obese Patients: Systematic Review and Meta-analysis. OBES SURG 26, 2590–2601 (2016). https://doi.org/10.1007/s11695-016-2144-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-016-2144-x

Keywords

Search

Navigation