• Annals of surgery · Dec 2021

    Esophageal Adenocarcinoma After Antireflux Surgery in a Cohort Study From the 5 Nordic Countries.

    • John Maret-Ouda, Giola Santoni, Karl Wahlin, Miia Artama, Nele Brusselaers, Martti Färkkilä, Elsebeth Lynge, Fredrik Mattsson, Eero Pukkala, Pål Romundstad, Laufey Tryggvadóttir, My von Euler-Chelpin, and Jesper Lagergren.
    • Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    • Ann. Surg. 2021 Dec 1; 274 (6): e535-e540.

    ObjectiveWe aimed to clarify the long-term risk development of EAC after antireflux surgery.Summary Of Background DataGastroesophageal reflux disease (GERD) increases EAC risk, but whether antireflux surgery prevents EAC is uncertain.MethodsMultinational, population-based cohort study including individuals with GERD from all 5 Nordic countries in 1964-2014. First, EAC risk after antireflux surgery in the cohort was compared with the corresponding background population by calculating standardized incidence ratios (SIRs) with 95% confidence intervals (95% CIs). Second, multivariable Cox proportional hazards regression, providing hazard ratios (HRs) with 95% CIs, compared EAC risk in GERD patients with antireflux surgery with those with nonsurgical treatment.ResultsAmong 942,071 GERD patients, 48,863 underwent surgery and 893,208 did not. Compared to the corresponding background population, EAC risk did not decrease after antireflux surgery [SIR 4.90 (95% CI 3.62-6.47) 1-<5 years and SIR 4.57 (95% CI 3.44-5.95) ≥15 years after surgery]. Similarly, no decrease was found for patients with severe GERD (esophagitis or Barrett esophagus) after surgery [SIR 6.09 (95% CI 4.39-8.23) 1-<5 years and SIR = 5.27 (95% CI 3.73-7.23) ≥15 years]. The HRs of EAC were stable comparing the surgery group with the nonsurgery group with GERD [HR 1.71 (95% CI 1.26-2.33) 1-<5 years and HR 1.69 (95% CI 1.24-2.30) ≥15 years after treatment], or for severe GERD [HR 1.56 (95% CI 1.11-2.20) 1-<5 years and HR 1.57 (95% CI 1.08-2.26) ≥15 years after treatment].ConclusionsSurgical treatment of GERD does not seem to reduce EAC risk.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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