The Risk of Esophageal Adenocarcinoma After Antireflux Surgery

Background & Aims

The question of a possible preventive effect of antireflux surgery on the development of esophageal or cardia adenocarcinoma remains unsettled. We aimed to clarify whether antireflux surgery prevents later development of esophageal adenocarcinoma.

Methods

We performed a Swedish population-based cohort study of antireflux surgery from 1965 to 2006. Follow-up evaluation for cancer and censoring for death and emigration were achieved up to December 31, 2006, through linkages to nationwide registers of cancer, population, and emigration. The cancer incidence in the antireflux surgery cohort was compared with that in the corresponding Swedish population. Relative risks were presented as standardized incidence ratios (SIRs), that is, the observed number of cancer cases in the antireflux surgery cohort divided by the expected number.

Results

The antireflux surgery cohort comprised 14,102 persons, contributing 120,514 person-years at risk. Overall risk of esophageal adenocarcinoma (n = 39) was increased 12-fold (SIR, 12.3; 95% confidence interval [CI], 8.7–16.8). No risk decrease with time after antireflux surgery was found (P = .86). After a postsurgical follow-up evaluation of 15 years or more, the SIR was 14.6 (95% CI, 7.0–26.8). For the corresponding overall risk of cardia adenocarcinoma (n = 21) the SIR was 4.4 (95% CI, 2.7–6.7), without any major decrease in risk with time (P = .20); the SIR was 3.1 (95% CI, 0.6–9.1) after at least 15 years of follow-up evaluation. No association between antireflux surgery and gastric adenocarcinoma or esophageal squamous cell carcinoma was identified.

Conclusions

Antireflux surgery cannot be considered to prevent the development of esophageal or cardia adenocarcinoma among persons with reflux.

Keywords: Neoplasm, Prevention, Fundoplication, Gastroesophageal Reflux, Esophagus, Cardia

Abbreviations used in this paper: CI, confidence interval, SIR, standardized incidence ratio