Introduction: Obesity is a chronic disease associated with increased risk for several cancers, including colorectal cancer (CRC), a leading cause of cancer-related mortality. The majority of CRC cases are associated with modifiable risk factors. Metabolic and bariatric surgery (MBS) is a proven, durable, and successful intervention for obesity. This study aimed to evaluate the impact of MBS on CRC risk through measures of association, such as relative risk (RR) and odds ratio (OR).Methods: A systematic search of PubMed, Scopus, Web of Science, ScienceDirect, and Embase was conducted to identify systematic reviews (SR) and meta-analyses examining the relationship between obesity treated with MBS and CRC incidence. The PICO framework guided inclusion criteria, and three independent reviewers screened articles using Rayyan software. Quality assessment was performed using AMSTAR2.Results: Of 1336 screened articles, 10 SR met inclusion criteria, encompassing 53,452,658 patients. Meta-analyses consistently showed a significant reduction in CRC risk following MBS in patients with severe obesity. Risk reductions were reported by Liu et al. (RR: 0.46, 95% CI: 0.32–0.67,p< 0.01), Chierici et al. (RR: 0.46, 95% CI: 0.28–0.75,p= 0.018), Wilson et al. (RR: 0.69, 95% CI: 0.53–0.88,p= 0.003), and Pararas et al. (RR: 0.56, 95% CI: 0.40–0.80,p< 0.001). Sensitivity analyses supported these findings. For colon cancer, Liu and Chierici both reported an RR of 0.75 (95% CI: 0.46–1.21,p= 0.2444) with significant heterogeneity (I2= 89%). A trend towards reduced rectal cancer risk (RR: 0.74, 95% CI: 0.40–1.39,p= 0.3523) was noted but limited by fewer studies. Sex-specific analyses revealed protective effects in both sexes, with a more pronounced impact in females (RR: 0.54, 95% CI: 0.37–0.79,p= 0.0014).Conclusions: This umbrella review synthesizes current evidence on the impact of MBS on CRC risk, highlighting a consistent protective association. The findings also indicate a potential risk reduction for both colon and rectal cancer, with a more pronounced effect observed among females compared to males. Given the profound implications of MBS on cancer incidence, morbidity, and mortality, further high-quality, long-term studies are essential to deepen our understanding and optimize its role in cancer prevention and patient care.
引言：肥胖是一种慢性疾病，与包括结直肠癌在内的多种癌症风险增加相关，而结直肠癌是癌症相关死亡的主要原因。大多数结直肠癌病例与可改变的风险因素有关。代谢与减重手术是经过验证、效果持久且成功的肥胖干预手段。本研究旨在通过相对风险和比值比等关联性测量指标，评估代谢与减重手术对结直肠癌风险的影响。 方法：系统检索了PubMed、Scopus、Web of Science、ScienceDirect和Embase数据库，以识别探讨经代谢与减重手术治疗的肥胖与结直肠癌发病率之间关系的系统综述和荟萃分析。采用PICO框架指导纳入标准，并由三位独立评审员使用Rayyan软件筛选文献。使用AMSTAR2工具进行质量评估。 结果：在1336篇筛选文献中，有10篇系统综述符合纳入标准，共涵盖53,452,658名患者。荟萃分析一致显示，重度肥胖患者在接受代谢与减重手术后，结直肠癌风险显著降低。Liu等人（RR: 0.46, 95% CI: 0.32–0.67, p < 0.01）、Chierici等人（RR: 0.46, 95% CI: 0.28–0.75, p = 0.018）、Wilson等人（RR: 0.69, 95% CI: 0.53–0.88, p = 0.003）以及Pararas等人（RR: 0.56, 95% CI: 0.40–0.80, p < 0.001）均报告了风险降低。敏感性分析支持这些发现。针对结肠癌，Liu和Chierici均报告相对风险为0.75（95% CI: 0.46–1.21, p = 0.2444），但存在显著异质性（I² = 89%）。观察到直肠癌风险降低的趋势（RR: 0.74, 95% CI: 0.40–1.39, p = 0.3523），但受限于研究数量较少。性别特异性分析显示，代谢与减重手术对两性均有保护作用，其中对女性的影响更为显著（RR: 0.54, 95% CI: 0.37–0.79, p = 0.0014）。 结论：本伞状综述综合了当前关于代谢与减重手术对结直肠癌风险影响的证据，强调其具有一致的保护性关联。研究结果还表明，代谢与减重手术可能降低结肠癌和直肠癌的风险，且与男性相比，对女性的保护作用更为明显。鉴于代谢与减重手术对癌症发病率、患病率和死亡率的深远影响，有必要开展更多高质量、长期的研究，以深化我们的理解并优化其在癌症预防和患者护理中的作用。
肿瘤(癌症)患者之家