Taha Qazi, MD: Evolving Bariatric Surgery Value in GI

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Data support the benefit of bariatric surgery in patients at high risk of pancreatic ductal adenocarcinoma due to BMI and metabolic comorbidities.

Bariatric surgery is associated with an independent protective benefit against oncogenesis of pancreatic ductal adenocarcinoma (PDAC) among patients with high body mass index (BMI) and ≥1 metabolic comoribidity, according to recent research from a team of Cleveland Clinic investigators.

The research penned by Stephen Firkins, MD, et al, and published in the third issue of Qazi Corner last month, provides what’s currently the largest analysis of bariatric surgery impact on pancreatic cancer. “It is reasonable to suggest that patients at increased risk of PDAC as well as other obesity-related malignancies may be recommended for surgically-assisted weight loss earlier and more frequently,” Firkins and colleagues wrote.

In the final segment of interview with HCPLive following the latest Qazi Corner, editor-in-chief Taha Qazi, MD, a gastroenterologist with the Cleveland Clinic, discussed the multifactorial impact of obesity on gastric disease and cancer risks—thereby warranting the extended research into bariatric intervention.

“We know that obesity has been linked to multiple complications, not only from the aspect of inflammation and pancreatitis, but also in general from a malignancy,” Qazi said. “And oftentimes what we’ll see is that there are certain associations of obesity linked to high risk of pancreas or colon cancer. The associations are not causality, but associations.”

Qazi stressed that, even beyond the impact bariatric surgery may play, it’s the timing of early intervention that’s vital for high-risk patients.

“I think most of our patients who have obesity also have significant cardiac and metabolic comoribidsites that put them at risk of malignancies and pre-malignancies in general,” Qazi said. “I think the issue is once we identify a patient as having these risk factors and also being obese, early evaluation with a bariatric surgeon and a motivated patient may be a strategy we can use.”

Of course, other options may exist as well.

“I think we’re entering a state now where we’re looking at not only bariatric surgery, but endoscopically, ways to manage weight loss that have been shown to be better in terms of complication rates and in terms of managing hypertension and diabetes,” Qazi said. “I think in many of our situations where we have a patient whose BMI may not meet certain criteria, but may have other comorbidities and may not be able to get the surgery, endoscopic operation may be something we could use.”

The Qazi Corner is a collaborative quarterly newsletter on gastroenterology research, news, and trends between HCPLive and editor-in-chief Taha Qazi, MD.

Read Firkins and colleagues’ analysis of bariatric surgery in PDAC cancer risk reduction here.