S0030 Roux-En-Y Gastric Bypass Is Associated With Higher Rates of Pancreatic Cysts and Pancreatic Adenocarcinoma When Compared to Laparoscopic Sleeve Gastrectomy: Findings of a Nationwide Analysis With Long-Term Follow-Up

Abstract

INTRODUCTION: Although obesity is associated with several gastrointestinal malignancies, the association between obesity and pancreatic adenocarcinoma (PAC) remains controversial. We aim to evaluate the rates of pancreatic cysts (PC) and PAC in obesity and in those who underwent roux-en-y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) using a large national database. METHODS: A commercial database (Explorys Inc, Cleveland, OH, USA), consisting of electronic health record data from 26 US healthcare systems, was surveyed. After excluding bariatric surgery, a cohort of patients with Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) diagnosis of “obesity” from 1999 to 2020 was identified. Within the obesity cohort, patients who developed new diagnoses of PC and PAC were identified. Subsequently, several cohorts of patients who underwent RYGB, LSG and LAGB were identified. The rates of new diagnoses of PC and PAC after at least 30 days of RYGB, LSG or LAGB were calculated. Risks of selected malignancies were compared amongst the obesity, RYGB, LSG and LAGB cohorts. RESULTS: Of the 72,531,460 patients in the database, 4,699,470 (6.5%), 40,250 (0.06%), and 58,520 (0.08%) with obesity, PC and PAC were identified respectively. There were 24,630 (0.03%) RYGB, 32,360 (0.09%) LSG and 8,650 (0.12%) LAGB cases in the database. There were 40 (0.16%), 30 (0.06%), and 10 (0.12%) of PC cases after at least 30 days of RYGB, LSG and LAGB respectively. Similarly, 140 (0.57%), 20 (0.06%) and 5 (0.06%) of PAC were identified after at least 30 days of RYGB, LSG and LAGB respectively. Patients who underwent RYGB were more likely to develop PC and PAC when compared to patients who underwent LSG (Table 1). Prevalence rates of PC and PAC overtime after bariatric surgery are presented in Figures 1 and 2 respectively. CONCLUSION: Patients who underwent RYGB had a higher risk of developing PC and PAC when compared to LSG and obese patients who did not undergo any bariatric procedure. This is the largest study to date to evaluate this topic. The underlying pathophysiology is unclear but is likely related to the permanent physiological and anatomical changes present in RYGB patients as compared to other types of bariatric interventions.Figure 1.: Proportion rates of pancreatic cyst (PC) after roux-en-y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) over a 10 year follow up. Please note that Explorys rounds to closet 0 or 10.Figure 2.: Proportion rates of pancreatic adenocarcinoma (PAC) after roux-en-y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) over a 10 year follow up. Please note that Explorys rounds to closet 0 or 10.Table 3.: Risk of pancreatic cyst (PC) and pancreatic adenocarcinoma (PAC) in roux-en-y gastric bypass (RYGB) vs. obesity (no bariatric surgery), RYGB vs. laparoscopic sleeve gastrectomy (LSG), RYGB vs. laparoscopic adjustable gastric banding (LAGB), LSG vs. obesity (no bariatric surgery), LSG vs. LAGB, and LAGB vs. obesity (no bariatric surgery). *P-value not significant. Please note that Explorys rounds to closet 0 or 10.