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Harutaka Inoue, MD; Francesco Rubino, MD; Yutaka Shimada, MD, PhD; Véronique Lindner, MD; Masako Inoue, BPharm; Philippe Riegel, MD; Jacques Marescaux, MD, FRCS

Arch Surg. 2007;142(10):947-953.

Objective  To evaluate the risk of gastric cancer after Roux-en-Y gastric bypass (RYGB).

Design  Rats randomly underwent 1 of the following: RYGB, duodenojejunal bypass (DJB), or a sham operation. Postoperatively, rats underwent a protocol of cancer induction by means of both continuous (200 ppm in tap water for 16 weeks) and intermittent (50-mg/kg intraesophageal injection, once a week, for 12 weeks) administration of N-methyl-N-nitrosourea.

Setting  Institut de Recherche Contre les Canceurs de l’Appareil Digestif–European Institute of Telesurgery.

Study Animals  Fifty-five Fischer 344 rats.

Main Outcome Measures  Seventeen weeks after the operation, we performed a pathologic examination of the whole stomach in all animals to assess for the presence of cancer and/or premalignant lesions. Bilirubin concentration, gastric bacterial flora, and any other pathologic findings were also recorded.

Results  In rats in the sham and DJB groups, the incidence of gastric cancer was 85% and 75%, respectively (P = .63), whereas only 23% of rats in the RYGB group developed gastric cancer (4-fold reduction; P = .002). The remnant stomach of rats in the RYGB group also showed a lower bilirubin concentration (P < .01) and a lower bacterial count (P < .05) compared with both the DJB and sham groups.

Conclusions  This study shows that RYGB reduces the risk of gastric cancer in an experimental model of dietary-induced carcinogenesis. Lack of direct contact with carcinogens, lower bile reflux, and a lower bacteria concentration in the gastric content may be responsible for these observations. These data suggest that RYGB may be a safe option for the treatment of morbid obesity even in areas with high gastric cancer incidence.

Author Affiliations: Institut de Recherche Contre les Canceurs de l’Appareil Digestif–European Institute of Telesurgery (Drs Inoue, Rubino, and Marescaux and Ms Inoue) and Laboratoire de Bactériologie (Dr Riegel), Louis Pasteur University, and Institute of Pathology, Hôpital Civil (Dr Lindner), Strasbourg, France; Department of Surgery, Catholic University, Rome, Italy (Dr Rubino); and Department of Surgery and Surgical Basic Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan (Drs Inoue and Shimada).

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