Metabolic-Bariatric Surgery Reduces Pancreatic Cancer Risk

Metabolic-bariatric surgery (MBS) appears to lower the risk for pancreatic cancer in people with obesity, with a potentially greater effect in those who also have type 2 diabetes (T2D), new research suggests.

In a meta-analysis of more than 3.7 million adults with obesity, those who had undergone MBS had less than half the risk for pancreatic cancer than those who didn’t undergo the surgery. The effect was smaller, but still significant, among those without T2D. The paper was published online on October 9, 2024, in Diabetes/Metabolism Research and Reviews.

“We know that both obesity and T2D are well-established risk factors for several cancers, including pancreatic cancer, which has one of the highest cancer-related mortality rates…Our study suggests that MBS has potential in reducing the risk of pancreatic cancer, particularly in high-risk populations such as those with obesity and T2D,” lead author Angeliki M. Angelidi, MD, PhD, of the Broad Institute of MIT and Harvard, Cambridge, and Harvard Medical School, Boston, told Medscape Medical News.

However, while the findings could have important clinical implications, Angelidi added that “at this time, we cannot recommend MBS solely for the purpose of reducing pancreatic cancer risk. Our findings…warrant further investigation, given the association of obesity and T2D with multiple malignancies.”

The meta-analysis analysis included 12 studies (11 cohort and 1 randomized trial) with a total of 3,711,243 adult participants, of whom 656,762 underwent MBS. All but three of the studies included a mixture of participants with and without T2D. The follow-up period ranged from 22 months to 33 years.

In four studies reporting on individuals with T2D, the incidence of pancreatic cancer was 0.04% for those who underwent MBS vs 0.29% for those who didn’t, producing a significantly lower relative risk of 0.21. Pancreatic cancer developed in 0.08% of those who didn’t vs 0.15% of those who did have T2D, with a significantly lower relative risk of 0.56.

For all groups combined, the relative risk for pancreatic cancer was 0.46 among those who underwent MBS.

In a second analysis of two studies comparing the risk for pancreatic cancer following MBS in people with and without T2D, there was a nonsignificant trend in favor of the T2D group, with a relative risk of 0.51.

“The greater reduction in pancreatic cancer risk observed in individuals with T2D was notable considering the added cancer risk in this group. This finding aligns with the idea that MBS may exert additional beneficial effects in individuals with T2D beyond just weight loss, potentially through metabolic improvements that warrant further investigation,” Angelidi said.

A subgroup analysis by continent showed that the reduction in the risk for pancreatic cancer was significantly lower in both American and European studies (0.70). And by the MBS type, sleeve gastrectomy was associated with a significantly lower relative risk of 0.24 for pancreatic cancer. For Roux-en-Y gastric bypass, the risk was reduced but not significantly (0.52).

Angelidi told Medscape Medical News, “More research is necessary, including well-designed, large-scale studies with long-term follow-up, to confirm the protective role of MBS in pancreatic cancer development. Given these findings, it would also be valuable to explore the effects of MBS on other T2D- and obesity-related malignancies. Such studies are crucial for clarifying the implications for clinical decision-making and identifying the patients that would benefit most from each intervention.”

The authors had no disclosures.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape Medical News, with other work appearing in the Washington Post, NPR’s Shots blog, and Diatribe. She is on X: @MiriamETucker.