La chirurgie bariatrique permet-elle une diminution du risque oncologique chez le sujet obèse ?
Tóm tắt
Il est aujourd’hui admis d’une part que l’obésité est un facteur de risque de cancer, et d’autre part que la chirurgie bariatrique permet une diminution de la morbi-mortalité globale du sujet obèse. Mais, la chirurgie bariatrique permet-elle une diminution du risque oncologique chez le sujet obèse ? Récemment, Tee et al ont publié une méta-analyse sur les principales études contrôlées sur ce sujet. Le risque relatif (RR) de cancer chez le sujet obèse après chirurgie bariatrique comparé à un sujet obèse non opéré était de 0,55 (IC95 [0,41–0,73], p<0,0001). Il était de 0,68 (IC95 [0,41–0,73], p<0,001) chez la femme et il n’y avait pas d’effet protecteur démontré chez l’homme (RR=0,99, IC95 [0,74–1,32]). L’incidence des cancers liés à l’obésité (œsophage, côlon-rectum, pancréas, sein, endomètre, rein, lymphome non Hodgkinien, leucémie, myélome multiple, foie et vésicule biliaire) serait plus particulièrement concernée par l’effet positif de la chirurgie bariatrique avec un hazard ratio à 0,62 (IC95 [0,49–0,78], p<0,0001) selon l’étude d’Adams. L’effet bénéfique de la chirurgie bariatrique sur l’hépatopathie stéatosique non alcoolique permettrait également en théorie une diminution du risque d’hépatocarcinome. Il en serait de même pour le reflux gastro-oesophagien (traité par gastric bypass) concernant l’adénocarcinome de l’œsophage. Il semblerait que la faible incidence de ces cancers associée à une faible puissance des études n’aie pas permis toutefois de mettre en évidence cette diminution d’incidence. Les explications mécanistiques pointent le rôle des cytokines inflammatoires et certaines hormones comme l’œstradiol, l’insuline, augmentées chez le sujet obèse et impliquées dans la tumorogenèse, et qui diminueraient après chirurgie bariatrique. L’adiponectine, augmentée après chirurgie bariatrique, serait également protectrice vis-à-vis du cancer. Ainsi, la chirurgie bariatrique, qui est aujourd’hui le moyen le plus efficace pour une perte de poids durable, semble, avec un haut niveau de preuve, réduire l’incidence de certains cancers.
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