What is the effect of gastrectomy in obese patients? New research proves it can save lives

Recently, the news of a well-known agent’s plan to undergo gastrectomy has become a hot topic, which has suddenly brought this kind of bariatric metabolic surgery into the spotlight. Of course, this kind of surgery is not “do as you want”, but has strict indications and indications, but for patients who really need the disease, how significant is the effect? Two papers published recently in annals of internal medicine, a journal of the American Medical Association, provide important evidence for this problem. < / P > < p > the first study, from a Canadian team, followed up more than 27000 obese patients with clinically matched clinical characteristics, and found that weight loss surgery significantly improved the 5-year mortality rate of patients. The team noted that the population-based matched cohort study was “the first and largest of its kind in Canada to date”. The second is a randomized controlled trial conducted by the Brazilian research team, focusing on whether the patients with mild to moderate obesity who are currently not recommended for surgery, such as those with refractory hypertension, can benefit from weight loss surgery. < / P > < p > in a study led by researchers at McMaster University in Canada, 13679 patients underwent weight loss surgery and the same number of non-surgical patients matched for age, gender, body mass index, and diabetes duration. The average preoperative body mass index (BMI) of patients undergoing surgery was as high as 47, and more than 81% of women. Among them, 87% of patients chose gastric bypass surgery (limiting intake and reducing absorption), and the remaining 13% underwent sleeve gastrectomy (mainly reducing gastric volume). During a median follow-up period of about 5 years, the overall mortality rate in the weight-loss group was 1.4%, compared with 2.5% in the non-surgical group, which was equivalent to a 32% reduction in the risk of all-cause mortality. In patients undergoing weight loss surgery, the risk of death from certain diseases was also improved, the risk of cardiovascular death was reduced by 47%, and the risk of cancer death was reduced by 46%. The absolute reduction of mortality in males and patients over 55 years old was 2.3% and 3.3%, respectively. Patients over 55 years old had a 47% lower risk of death after weight loss surgery, while those under 45 years old had no significant improvement. It is worth noting that some previous views have brought new insights into the view that older patients undergoing surgery will not be able to reverse their condition, taking into account the perioperative risks and the health injuries already formed. Compared with patients with BMI of 40-50, the patients with BMI of 40-50 had the most significant benefit, and the risk of all-cause death decreased by 38%. However, the effect of surgery on the risk of death was not observed in patients with preoperative BMI ≤ 40. < p > < p > in a randomized controlled trial in Brazil, 100 patients with mild to moderate obesity (BMI 30-39.9) with hypertension and poor drug control were randomly assigned to receive weight loss surgery and lifestyle counseling, or only lifestyle counseling; both groups also received standard drug treatment for hypertension. < p > < p > at the 3-year follow-up, 73% of patients undergoing weight loss surgery and 11% of patients in the control group reduced the amount of antihypertensive drugs (including drug type and dosage) by 30% while maintaining blood pressure standard (< 140 / 90 mm Hg). Statistically speaking, patients with weight loss surgery are 6.5 times more likely to be successful in drug reduction than non-surgical patients. < / P > < p > at the same time, more patients in the operation group only need to take one antihypertensive drug, or even more than 30% of patients can maintain blood pressure standard (< lt; 140 / 90 mm Hg, 35% vs 2%) or better (< lt; 130 / 80 mm Hg, 31% vs 0%). In addition, in the operation group, the average weight loss was 27.8%, while in the control group, the weight was almost unchanged. < / P > < p > in an editorial published in the same period, Dr. Christina wee, associate editor of annals of internal medicine and Beth Israel Deaconess Medical Center, pointed out that “metabolic surgery can not only reduce weight, but also improve the adverse metabolic effects of obesity through changes in neurohormones. Long term observational studies have shown that the risk of death after weight loss surgery is reduced by more than 50%, especially in patients undergoing gastric bypass surgery. ” < / P > < p > combined with two recent studies, she believes the findings provide more supporting evidence for the benefits of gastric bypass surgery. “Gastric bypass surgery can be an option for obese patients; weight loss surgery may also be an appropriate option for patients with mild obesity and refractory hypertension, or for patients who need to reduce the type of medication they take.” For the first large study, the benefit of sleeve gastrectomy was not obvious, and it was suggested that the results should be considered as “hypothesis making” because of the small number of patients.

　　Christina Dr. wee also stressed that this does not mean that weight-loss surgery should be recommended under any circumstances. For patients with mild obesity, no complications and good blood pressure control, these data do not support the “routine recommendation of weight loss surgery”, nor do they support the “early weight loss surgery ratio” for “managing the cardiac metabolic effects of obesity, especially in patients without type 2 diabetes mellitus” Step by step treatment is better.