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

doi:10.3877/cma.j.issn.2095-9605.2025.04.009

Abstract

Abstract:

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.

Key words: Bariatric surgery, Colorectal cancer, Risk factors, Mechanism

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

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References 68

[1]	Blüher M. Obesity: global epidemiology and pathogenesis[J]. Nature Reviews Endocrinology, 2019, 15(5): 288-298.
[2]	van Veldhuisen SL, Gorter TM, van Woerden G, et al. Bariatric surgery and cardiovascular disease: a systematic review and meta-analysis[J]. European Heart Journal, 2022, 43(20): 1955-1969.
[3]	Courcoulas AP, Patti ME, Hu B, et al. Long-term outcomes of medical management vs bariatric surgery in type 2 diabetes [J]. JAMA, 2024, 331(8): 654-664.
[4]	Reis MG, Guimarães G. Moreira LF, Siqueira Veloso de Andrade Carvalho L, et al. Weight regain after bariatric surgery: A systematic review and meta-analysis of observational studies[J]. Obesity Medicine, 2024, 45: 100528.
[5]	Madar LO, Goldberg N, Netz U, et al. Association between metabolic and bariatric surgery and malignancy: a systematic review, meta-analysis, trends, and conclusions [J]. Surgery for Obesity and Related Diseases: Official Journal of the American Society for Bariatric Surgery, 2025, 21(4): 434-448.
[6]	Davey MG, Ryan OK, Ryan éJ, et al. The Impact of Bariatric Surgery on the Incidence of Colorectal Cancer in Patients with Obesity-a Systematic Review and Meta-analysis of Registry Data[J]. Obesity Surgery, 2023, 33(8): 2293-2302.
[7]	Schauer DP, Feigelson HS, Koebnick C, et al. Bariatric Surgery and the Risk of Cancer in a Large Multisite Cohort [J]. Annals of Surgery, 2019, 269(1): 95-101.
[8]	Almazeedi S, El-Abd R, Al-Khamis A, et al. Role of bariatric surgery in reducing the risk of colorectal cancer: a meta-analysis[J]. The British Journal of Surgery, 2020, 107(4): 348-354.
[9]	Janik MR, Clapp B, Sroczyński P, et al. The effect of bariatric surgery on reducing the risk of colorectal cancer: a meta-analysis of 3,233,044 patients[J]. Surgery for Obesity and Related Diseases: Official Journal of the American Society for Bariatric Surgery, 2023, 19(4): 328-334.
[10]	Kwak M, Mehaffey JH, Hawkins RB, et al. Bariatric surgery is independently associated with a decrease in the development of colorectal lesions[J]. Surgery, 2019, 166(3): 322-326.
[11]	Ciccioriccio MC, Iossa A, Boru CE, et al. Colorectal cancer after bariatric surgery (Cric-Abs 2020): Sicob (Italian society of obesity surgery) endorsed national survey[J]. International Journal of Obesity, 2021, 45(12): 2527-2531.
[12]	Chierici A, Amoretti P, Drai C, et al. Does Bariatric Surgery Reduce the Risk of Colorectal Cancer in Individuals with Morbid Obesity? A Systematic Review and Meta-Analysis[J]. Nutrients, 2023, 15(2): 467.
[13]	Goyal A, Macias CA, Corzo MP, et al. Outcomes of Metabolic and Bariatric Surgery in Populations with Obesity and Their Risk of Developing Colorectal Cancer: Where Do We Stand? An Umbrella Review on Behalf of TROGSS—The Robotic Global Surgical Society[J]. Cancers, 2025, 17(4): 670.
[14]	Pararas N, Pikouli A, Dellaportas D, et al. The Protective Effect of Bariatric Surgery on the Development of Colorectal Cancer: A Systematic Review and Meta-Analysis[J]. International Journal of Environmental Research and Public Health, 2023, 20(5): 3981.
[15]	Luo JN, Haridas RS, Lo T, et al. Sleeve gastrectomy promotes colitis-associated colorectal cancer in a murine model via a modified gut microbiome[J]. bioRxiv, 2022: 2022.06.04.494831.
[16]	Derogar M, Hull MA, Kant P, et al. Increased risk of colorectal cancer after obesity surgery[J]. Annals of Surgery, 2013, 258(6): 983-988.
[17]	Tao W, Artama M, von Euler-Chelpin M, et al. Colon and rectal cancer risk after bariatric surgery in a multicountry Nordic cohort study[J]. International Journal of Cancer, 2020, 147(3): 728-735.
[18]	Ostlund MP, Lu Y, Lagergren J. Risk of obesity-related cancer after obesity surgery in a population-based cohort study[J]. Annals of Surgery, 2010, 252(6): 972-976.
[19]	Lim PW, Stucky CCH, Wasif N, et al. Bariatric Surgery and Longitudinal Cancer Risk: A Review[J]. JAMA surgery, 2024, 159(3): 331-338.
[20]	Liu YN, Gu JF, Zhang J, et al. Bariatric surgery reduces colorectal cancer incidence in obese individuals: Systematic review and meta-analysis[J]. World Journal of Gastrointestinal Surgery, 2023, 15(10): 2331-2342.
[21]	Renehan AG, Tyson M, Egger M, et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies[J]. Lancet (London, England), 2008, 371(9612): 569-578.
[22]	Larsson SC, Wolk A. Obesity and colon and rectal cancer risk: a meta-analysis of prospective studies[J]. The American Journal of Clinical Nutrition, 2007, 86(3): 556-565.
[23]	Peleg N, Sapoznikov S, Levi Z, et al. Incidence of Colorectal Adenomas After Bariatric Surgery: Pre-operative Super Morbid Obesity Is Independently Associated with Increased Risk[J]. Obesity Surgery, 2021, 31(10): 4220-4226.
[24]	Mackenzie H, Markar SR, Askari A, et al. Obesity surgery and risk of cancer[J]. The British Journal of Surgery, 2018, 105(12): 1650-1657.
[25]	Hussan H, Drosdak A, Le Roux M, et al. The Long-term Impact of Roux-en-Y Gastric Bypass on Colorectal Polyp Formation and Relation to Weight Loss Outcomes[J]. Obesity Surgery, 2020, 30(2): 407-415.
[26]	Hussan H, Akinyeye S, Mihaylova M, et al. Colorectal Cancer Risk Is Impacted by Sex and Type of Surgery After Bariatric Surgery[J]. Obesity Surgery, 2022, 32(9): 2880-2890.
[27]	Kant P, Sainsbury A, Reed KR, et al. Rectal epithelial cell mitosis and expression of macrophage migration inhibitory factor are increased 3 years after Roux-en-Y gastric bypass (RYGB) for morbid obesity: implications for long-term neoplastic risk following RYGB[J]. Gut, 2011, 60(7): 893-901.
[28]	Sainsbury A, Goodlad RA, Perry SL, et al. Increased colorectal epithelial cell proliferation and crypt fission associated with obesity and roux-en-Y gastric bypass[J]. Cancer Epidemiology, Biomarkers & Prevention: A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, 2008, 17(6): 1401-1410.
[29]	Guo Y, Liu CQ, Liu GP, et al. Roux-en-Y gastric bypass decreases endotoxemia and inflammatory stress in association with improvements in gut permeability in obese diabetic rats[J]. Journal of Diabetes, 2019, 11(10): 786-793.
[30]	Ayiomamitis GD, Notas G, Vasilakaki T, et al. Understanding the Interplay between COX-2 and hTERT in Colorectal Cancer Using a Multi-Omics Analysis[J]. Cancers, 2019, 11(10): 1536.
[31]	Hussan H, Clinton SK, Grainger EM, et al. Distinctive patterns of sulfide- and butyrate-metabolizing bacteria after bariatric surgery: potential implications for colorectal cancer risk[J]. Gut Microbes, 2023, 15(2): 2255345.
[32]	Graessler J, Qin Y, Zhong H, et al. Metagenomic sequencing of the human gut microbiome before and after bariatric surgery in obese patients with type 2 diabetes: correlation with inflammatory and metabolic parameters[J]. The Pharmacogenomics Journal, 2013, 13(6): 514-522.
[33]	Mabey JG, Chaston JM, Castro DG, et al. Gut microbiota differs a decade after bariatric surgery relative to a nonsurgical comparison group[J]. Surgery for Obesity and Related Diseases: Official Journal of the American Society for Bariatric Surgery, 2020, 16(9): 1304-1311.
[34]	Debédat J, Clément K, Aron-Wisnewsky J. Gut Microbiota Dysbiosis in Human Obesity: Impact of Bariatric Surgery[J]. Current Obesity Reports, 2019, 8(3): 229-242.
[35]	Koulas SG, Stefanou CK, Stefanou SK, et al. Gut Microbiota in Patients with Morbid Obesity Before and After Bariatric Surgery: a Ten-Year Review Study (2009-2019)[J]. Obesity Surgery, 2021, 31(1): 317-326.
[36]	Palmisano S, Campisciano G, Iacuzzo C, et al. Role of preoperative gut microbiota on colorectal anastomotic leakage: preliminary results[J]. Updates in Surgery, 2020, 72(4): 1013-1022.
[37]	Wang L, Tang L, Feng Y, et al. A purified membrane protein from Akkermansia muciniphila or the pasteurised bacterium blunts colitis associated tumourigenesis by modulation of CD8+ T cells in mice[J]. Gut, 2020, 69(11): 1988-1997.
[38]	Jiang Y, Xu Y, Zheng C, et al. Acetyltransferase from Akkermansia muciniphila blunts colorectal tumourigenesis by reprogramming tumour microenvironment[J]. Gut, 2023, 72(7): 1308-1318.
[39]	Fan L, Xu C, Ge Q, et al. A. Muciniphila Suppresses Colorectal Tumorigenesis by Inducing TLR2/NLRP3-Mediated M1-Like TAMs[J]. Cancer Immunology Research, 2021, 9(10): 1111-1124.
[40]	Zhou L, Zhang M, Wang Y, et al. Faecalibacterium prausnitzii Produces Butyrate to Maintain Th17/Treg Balance and to Ameliorate Colorectal Colitis by Inhibiting Histone Deacetylase 1[J]. Inflammatory Bowel Diseases, 2018, 24(9): 1926-1940.
[41]	Dikeocha IJ, Al-Kabsi AM, Chiu HT, et al. Faecalibacterium prausnitzii Ameliorates Colorectal Tumorigenesis and Suppresses Proliferation of HCT116 Colorectal Cancer Cells[J]. Biomedicines, 2022, 10(5): 1128.
[42]	Li JV, Reshat R, Wu Q, et al. Experimental bariatric surgery in rats generates a cytotoxic chemical environment in the gut contents[J]. Frontiers in Microbiology, 2011, 2: 183.
[43]	Abed J, Emgård JEM, Zamir G, et al. Fap2 Mediates Fusobacterium nucleatum Colorectal Adenocarcinoma Enrichment by Binding to Tumor-Expressed Gal-GalNAc[J]. Cell Host & Microbe, 2016, 20(2): 215-225.
[44]	Glymenaki M, Curio S, Shrestha S, et al. Roux-en-Y gastric bypass-associated fecal tyramine promotes colon cancer risk via increased DNA damage, cell proliferation, and inflammation[J]. Microbiome, 2025, 13(1): 60.
[45]	Pournaras DJ, Glicksman C, Vincent RP, et al. The role of bile after Roux-en-Y gastric bypass in promoting weight loss and improving glycaemic control[J]. Endocrinology, 2012, 153(8): 3613-3619.
[46]	Patti ME, Houten SM, Bianco AC, et al. Serum bile acids are higher in humans with prior gastric bypass: potential contribution to improved glucose and lipid metabolism[J]. Obesity (Silver Spring, Md.), 2009, 17(9): 1671-1677.
[47]	Chaudhari SN, Luo JN, Harris DA, et al. A microbial metabolite remodels the gut-liver axis following bariatric surgery[J]. Cell Host & Microbe, 2021, 29(3): 408-424.e7.
[48]	Wang M, Li L, Chen Y, et al. Role of Gut Microbiome and Microbial Metabolites in Alleviating Insulin Resistance After Bariatric Surgery[J]. Obesity Surgery, 2021, 31(1): 327-336.
[49]	Cai J, Sun L, Gonzalez FJ. Gut microbiota-derived bile acids in intestinal immunity, inflammation, and tumorigenesis[J]. Cell Host & Microbe, 2022, 30(3): 289-300.
[50]	Bayerdörffer E, Mannes GA, Richter WO, et al. Increased serum deoxycholic acid levels in men with colorectal adenomas[J]. Gastroenterology, 1993, 104(1): 145-151.
[51]	Bernstein C, Holubec H, Bhattacharyya AK, et al. Carcinogenicity of deoxycholate, a secondary bile acid[J]. Archives of Toxicology, 2011, 85(8): 863-871.
[52]	Nguyen TT, Ung TT, Kim NH, et al. Role of bile acids in colon carcinogenesis[J]. World Journal of Clinical Cases, 2018, 6(13): 577-588.
[53]	Jia W, Xie G, Jia W. Bile acid-microbiota crosstalk in gastrointestinal inflammation and carcinogenesis[J]. Nature Reviews. Gastroenterology & Hepatology, 2018, 15(2): 111-128.
[54]	Nguyen TT, Ung TT, Li S, et al. Metformin inhibits lithocholic acid-induced interleukin 8 upregulation in colorectal cancer cells by suppressing ROS production and NF-kB activity[J]. Scientific Reports, 2019, 9(1): 2003.
[55]	Lässle C, Mauerer B, Marx L, et al. Metabolic surgery reduces CRC disease progression through circulating bile acid diversion[J]. Science Translational Medicine, 2025, 17(804): eads9705.
[56]	D’Amato S, Sofia M, Agosta M, et al. The impact of bariatric surgery on colorectal cancer risk[J]. Surgery for Obesity and Related Diseases: Official Journal of the American Society for Bariatric Surgery, 2023, 19(2): 144-157.
[57]	Monleón D, Morales JM, Barrasa A, et al. Metabolite profiling of fecal water extracts from human colorectal cancer[J]. NMR in biomedicine, 2009, 22(3): 342-348.
[58]	Walker AW, Duncan SH, McWilliam Leitch EC, et al. pH and peptide supply can radically alter bacterial populations and short-chain fatty acid ratios within microbial communities from the human colon[J]. Applied and Environmental Microbiology, 2005, 71(7): 3692-3700.
[59]	Juárez-Fernández M, Román-Sagüillo S, Porras D, et al. Long-Term Effects of Bariatric Surgery on Gut Microbiota Composition and Faecal Metabolome Related to Obesity Remission[J]. Nutrients, 2021, 13(8): 2519.
[60]	Seyfried F, Phetcharaburanin J, Glymenaki M, et al. Roux-en-Y gastric bypass surgery in Zucker rats induces bacterial and systemic metabolic changes independent of caloric restriction-induced weight loss[J]. Gut Microbes, 2021, 13(1): 1-20.
[61]	Martínez-Sánchez MA, Balaguer-Román A, Fernández-Ruiz VE, et al. Plasma short-chain fatty acid changes after bariatric surgery in patients with severe obesity[J]. Surgery for Obesity and Related Diseases: Official Journal of the American Society for Bariatric Surgery, 2023, 19(7): 727-734.
[62]	Huang X, Oshima T, Tomita T, et al. Butyrate Alleviates Cytokine-Induced Barrier Dysfunction by Modifying Claudin-2 Levels[J]. Biology, 2021, 10(3): 205.
[63]	Cunningham RM, Jones KT, Kuhn JE, et al. Asymptomatic Cholelithiasis and Bariatric Surgery: a Comprehensive Long-Term Analysis of the Risks of Biliary Disease in Patients Undergoing Primary Roux-en-Y Gastric Bypass[J]. Obesity Surgery, 2021, 31(3): 1249-1255.
[64]	Tang B, Li S, Li X, et al. Cholecystectomy-related gut microbiota dysbiosis exacerbates colorectal tumorigenesis[J]. Nature Communications, 2025, 16(1): 7638.
[65]	Devkota S, Wang Y, Musch MW, et al. Dietary-fat-induced taurocholic acid promotes pathobiont expansion and colitis in Il10-/- mice[J]. Nature, 2012, 487(7405): 104-108.
[66]	Sheng L, Jena PK, Hu Y, et al. Hepatic inflammation caused by dysregulated bile acid synthesis is reversible by butyrate supplementation[J]. The Journal of Pathology, 2017, 243(4): 431-441.
[67]	Ghenu MI, Dragoş D, Manea MM, et al. Pathophysiology of sepsis-induced cholestasis: A review[J]. JGH open: an open access journal of gastroenterology and hepatology, 2022, 6(6): 378-387.
[68]	Song L, Hou Y, Xu D, et al. Hepatic FXR-FGF4 is required for bile acid homeostasis via an FGFR4-LRH-1 signal node under cholestatic stress[J]. Cell Metabolism, 2025, 37(1): 104-120.e9.

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

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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