Esophageal Adenocarcinoma After Antireflux Surgery in a Cohort Study From the 5 Nordic Countries
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Esophageal Adenocarcinoma After Antireflux Surgery in a Cohort Study From the 5 Nordic Countries. / Maret-Ouda, John; Santoni, Giola; Wahlin, Karl; Artama, Miia; Brusselaers, Nele; Farkkila, Martti; Lynge, Elsebeth; Mattsson, Fredrik; Pukkala, Eero; Romundstad, Pal; Tryggvadottir, Laufey; Von Euler-Chelpin, My; Lagergren, Jesper.
In: Annals of Surgery, Vol. 274, No. 6, 2021, p. E535-E540.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Esophageal Adenocarcinoma After Antireflux Surgery in a Cohort Study From the 5 Nordic Countries
AU - Maret-Ouda, John
AU - Santoni, Giola
AU - Wahlin, Karl
AU - Artama, Miia
AU - Brusselaers, Nele
AU - Farkkila, Martti
AU - Lynge, Elsebeth
AU - Mattsson, Fredrik
AU - Pukkala, Eero
AU - Romundstad, Pal
AU - Tryggvadottir, Laufey
AU - Von Euler-Chelpin, My
AU - Lagergren, Jesper
PY - 2021
Y1 - 2021
N2 - Objective: We aimed to clarify the long-term risk development of EAC after antireflux surgery.Summary of Background Data: Gastroesophageal reflux disease (GERD) increases EAC risk, but whether antireflux surgery prevents EAC is uncertain.Methods: Multinational, 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.Results: Among 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].Conclusions: Surgical treatment of GERD does not seem to reduce EAC risk.
AB - Objective: We aimed to clarify the long-term risk development of EAC after antireflux surgery.Summary of Background Data: Gastroesophageal reflux disease (GERD) increases EAC risk, but whether antireflux surgery prevents EAC is uncertain.Methods: Multinational, 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.Results: Among 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].Conclusions: Surgical treatment of GERD does not seem to reduce EAC risk.
KW - esophageal neoplasm
KW - fundoplication
KW - population-based
KW - proton pump inhibitor
KW - risk
U2 - 10.1097/SLA.0000000000003709
DO - 10.1097/SLA.0000000000003709
M3 - Journal article
C2 - 31800492
VL - 274
SP - E535-E540
JO - Advances in Surgery
JF - Advances in Surgery
SN - 0003-4932
IS - 6
ER -
ID: 286005177