Risk of Esophageal Adenocarcinoma After Antireflux Surgery in Patients With Gastroesophageal Reflux Disease in the Nordic Countries

• Published in: JAMA Oncology
• Main Authors: Maret-Ouda, John, Wahlin, Karl, Artama, Miia, Brusselaers, Nele, Färkkilä, Martti, Lynge, Elsebeth, Mattsson, Fredrik, Pukkala, Eero, Romundstad, Pål, Tryggvadóttir, Laufey, von Euler-Chelpin, My, Lagergren, Jesper
• Format: Text
• Language: English
• Published: American Medical Association 2018
• Subjects: Original Investigation; Gerd; Norway; Iceland
• Online Access: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248086/; http://www.ncbi.nlm.nih.gov/pubmed/30422249; https://doi.org/10.1001/jamaoncol.2018.3054

IMPORTANCE: Gastroesophageal reflux disease (GERD) is associated with a strong and severity-dependent increased risk of esophageal adenocarcinoma. Whether antireflux surgery prevents esophageal adenocarcinoma is a matter of uncertainty. OBJECTIVES: To examine whether antireflux surgery is associated with reduced risk of esophageal adenocarcinoma and whether the risk is different between surgically and medically treated patients. DESIGN, SETTING, AND PARTICIPANTS: In this multinational, population-based retrospective cohort study from Denmark, Finland, Iceland, Norway, and Sweden, patients undergoing surgery were followed up for a median of 12.7 years, and a comparison group of patients receiving medication only were followed up for a median of 4.8 years. All patients with a registered diagnosis of GERD (or an associated disorder), including 48 414 individuals undergoing surgery and 894 492 receiving medication only, were included in the study. The study periods varied in the different countries depending on the year of initiation of registration and the date of data retrieval, from January 1, 1964, to December 21, 2014. EXPOSURES: Antireflux surgery for GERD. MAIN OUTCOMES AND MEASURES: The risk of esophageal adenocarcinoma over time after surgery was compared with that in a corresponding background population using standardized incidence ratios (SIRs) with 95% CIs and with patients with GERD who received medication using multivariable Cox proportional hazards regression, providing hazard ratios (HRs) with 95% CIs adjusted for confounders. RESULTS: In this study of 942 906 patients with GERD, 48 414 underwent antireflux surgery (median [interquartile range] age, 66.0 [58.0-73.0] years; 27 161 male [56.1%]) and 894 492 received medication only (median [interquartile range] age, 71.0 [62.0-78.0] years; 434 035 male [48.6%]). Among patients undergoing surgery, 177 developed esophageal adenocarcinoma. Esophageal adenocarcinoma risk decreased in a time-dependent manner after surgery compared with the background ...