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中华肥胖与代谢病电子杂志 ›› 2025, Vol. 11 ›› Issue (04) : 318 -324. doi: 10.3877/cma.j.issn.2095-9605.2025.04.009

综述

减重手术对结直肠癌发病风险的影响及其作用机制
毛洁芹1, 蒲雨馨2, 柯志刚1,(), 童卫东1,()   
  1. 1400042 重庆,陆军军医大学大坪医院普通外科
    2400042 重庆,陆军军医大学大坪医院消化内科
  • 收稿日期:2025-07-23 出版日期:2025-11-30
  • 通信作者: 柯志刚, 童卫东
  • 基金资助:
    国家自然科学基金面上项目(82570946)

The impact and mechanisms of bariatric surgery on the risk of colorectal cancer

Jieqin Mao1, Yuxin Pu2, Zhigang Ke1,(), Weidong Tong1,()   

  1. 1Department of General Surgery, Daping Hospital, Army Medicial University, Chongqing 400042, China
    2Department of Gastroenterology, Daping Hospital, Army Medicial University, Chongqing 400042, China
  • Received:2025-07-23 Published:2025-11-30
  • Corresponding author: Zhigang Ke, Weidong Tong
引用本文:

毛洁芹, 蒲雨馨, 柯志刚, 童卫东. 减重手术对结直肠癌发病风险的影响及其作用机制[J/OL]. 中华肥胖与代谢病电子杂志, 2025, 11(04): 318-324.

Jieqin Mao, Yuxin Pu, Zhigang Ke, Weidong Tong. The impact and mechanisms of bariatric surgery on the risk of colorectal cancer[J/OL]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2025, 11(04): 318-324.

减重手术作为肥胖症及其代谢相关合并症的有效治疗方法,其对患者术后结直肠癌发病风险的影响尚存争议。尽管多数临床队列研究证实减重手术可显著降低结直肠癌发病率,但仍有部分研究观察到术后结直肠癌风险升高的矛盾现象。基于此,有必要进一步阐明减重手术对结直肠癌发病风险的影响及可能的作用机制。本文系统回顾和总结了国内外现有关于减重手术对肥胖症患者结直肠癌发病率影响的研究,并深入探讨了减重手术对结直肠癌发病率影响的可能机制。

Bariatric surgery, as an effective method for obesity and its metabolism-related complications, its impact on the risk of postoperative colorectal cancer (CRC) remains controversial. Although most clinical cohort studies have confirmed that bariatric surgery can significantly reduce the incidence of CRC, some studies have still observed a paradoxical increase. Therefore, it is necessary to further clarify the effect of bariatric surgery on the risk of CRC and its possible mechanism. This article presents a comprehensive systematic review and synthesis of current domestic and international research examining the impact of bariatric surgery on CRC incidence among obese patients, while also exploring potential underlying mechanisms for this observed effect.

表1 减重手术对CRC发病风险的影响
参考文献 时间 参与者 手术类型 CRC发病风险 随访时间
[6] 2023 接受手术:872,499
未接受手术:5,432,183
SG、RYGB 降低 平均随访5.1年
[7] 2019 接受手术:22,198
未接受手术:66,427
未说明 降低 平均随访3.5年
[8] 2020 1,213,727 RYGB、SG、AGB、BPD-DS、VBG 降低 平均随访时间未说明
[9] 2023 3,233,044 未说明 降低 平均随访9.5 ± 7.9年
[10] 2019 接受手术:3,676
未接受手术:46,873
SG、RYGB 降低 中位随访时间为7.8年
[11] 2021 20,571 SG、RYGB 降低 随访时间5-10年
[12] 2023 12,517,893 SG、RYGB、其他 降低 平均随访时间未说明
[13] 2025 53,452,658 SG、RYGB、其他 降低 平均随访时间未说明
[14] 2023 6,279,722 SG、RYGB、其他 降低 平均随访时间未说明
[5] 2024 11,789 SG、RYGB、其他 降低 平均随访时间未说明
[20] 2023 12,497,322 SG、RYGB 降低 平均随访时间未说明
[16] 2013 接受手术:15,095
未接受手术:62,016
VBG、AGB、RYGB 升高 手术队列中位随访时间10年
非手术队列中位随访时间7年
[17] 2020 接受手术:49,931
未接受手术:492,427
RYGB、限制性代谢手术、其他 升高 平均随访时间未说明
[18] 2010 13,123 VBG、AGB、RYGB 升高 平均随访时间未说明
[23] 2021 1,639 RYGB、SG、OAGB、BPD-DS 升高 随访时间9年
[24] 2018 接受手术:8,794
未接受手术:8,794
SG、AGB、RYGB 升高 中位随访时间55个月
[25] 2020 RYGB术前:106
RYGB术后:86
RYGB 升高 随访时间≥5年
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