Maret-Ouda J, et al. - Researchers sought for the link between antireflux surgery for gastroesophageal reflux disease (GERD) and risk of esophageal adenocarcinoma. They also compared the risk between surgically and medically treated patients. Findings suggested that effective treatment of GERD might prevent esophageal adenocarcinoma. A similar reduced esophageal adenocarcinoma risk was observed in relation to medical and surgical treatment of GERD, with the risk decreasing to the same level as that in the background population over time.

Methods

• This is a multinational, population-based retrospective cohort study from Denmark, Finland, Iceland, Norway, and Sweden.
• Participants were patients with a registered diagnosis of GERD (or an associated disorder), including 48,414 individuals undergoing surgery followed up for a median of 12.7 years and 894,492 receiving medication only (comparison group) followed up for a median of 4.8 years.
• Based on the year of initiation of registration and the date of data retrieval, study periods varied in the different countries, from January 1, 1964, to December 21, 2014.
• Exposures included antireflux surgery for GERD.
• Researchers used standardized incidence ratios (SIRs) with 95% CIs to compare the risk of esophageal adenocarcinoma over time after surgery with that in a corresponding background population.
• They used multivariable Cox proportional hazards regression, providing hazard ratios (HRs) with 95% CIs adjusted for confounders, to compare the risk of esophageal adenocarcinoma over time after surgery with patients with GERD who received medication.

Results

• Of total 942,906 patients with GERD, 48,414 had 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%]).
• The development of esophageal adenocarcinoma was reported in 177 of those who had surgery.
• In the surgery group vs in the background population, a time-dependent reduction in esophageal adenocarcinoma risk was observed after surgery (5 to <10 years after surgery: SIR,7.63; 95% CI, 5.42-10.43; ≥15 years after surgery: SIR, 1.34; 95% CI, 0.98-1.80).
• The observed SIRs were 10.08 (95% CI, 6.98-14.09) and 1.67 (95% CI, 1.15-2.35) at 5 to less than 10 years after surgery and at 15 years or more after surgery, respectively, in patients with more severe and objectively determined GERD.
• Over the time, no change was evident in the risk of esophageal adenocarcinoma in surgical patients vs in patients who received medication only (5 to <10 years after surgery: HR, 2.02; 95% CI, 1.44-2.84; ≥15 years: HR, 1.80; 95% CI, 1.28-2.54).
• In analyses restricted to severe reflux disease, a stable risk was observed over time (5 to <10 years after surgery: HR, 1.81; 95% CI, 1.24-2.63; ≥15 years after surgery: HR, 1.69; 95% CI, 1.14-2.51).