Esophageal Adenocarcinoma After Antireflux Surgery in a Cohort Study From the 5 Nordic Countries.

Supplemental Digital Content is available in the text Objective: We aimed to clarify the long-term risk development of EAC after antireflux surgery. Summary of Background Data: Gastroesophageal reflux disease (GERD) increases EAC risk, but whether antireflux surgery prevents EAC is uncertain. Methods: Multinational, population-based cohort study including individuals with GERD from all 5 Nordic countries in 1964–2014. First, EAC risk after antireflux surgery in the cohort was compared with the corresponding background population by calculating standardized incidence ratios (SIRs) with 95% confidence intervals (95% CIs). Second, multivariable Cox proportional hazards regression, providing hazard ratios (HRs) with 95% CIs, compared EAC risk in GERD patients with antireflux surgery with those with nonsurgical treatment. Results: Among 942,071 GERD patients, 48,863 underwent surgery and 893,208 did not. Compared to the corresponding background population, EAC risk did not decrease after antireflux surgery [SIR 4.90 (95% CI 3.62–6.47) 1–<5 years and SIR 4.57 (95% CI 3.44–5.95) ≥15 years after surgery]. Similarly, no decrease was found for patients with severe GERD (esophagitis or Barrett esophagus) after surgery [SIR 6.09 (95% CI 4.39–8.23) 1–<5 years and SIR = 5.27 (95% CI 3.73–7.23) ≥15 years]. The HRs of EAC were stable comparing the surgery group with the nonsurgery group with GERD [HR 1.71 (95% CI 1.26–2.33) 1–<5 years and HR 1.69 (95% CI 1.24–2.30) ≥15 years after treatment], or for severe GERD [HR 1.56 (95% CI 1.11–2.20) 1–<5 years and HR 1.57 (95% CI 1.08–2.26) ≥15 years after treatment]. Conclusions: Surgical treatment of GERD does not seem to reduce EAC risk. [ABSTRACT FROM AUTHOR]