Exploring the impact of metabolic and bariatric surgery on reducing hepatocellular carcinoma risk in obesity: insights from a nationwide French study

Objective: To evaluate the impact of metabolic and bariatric surgery (MBS)on the incidence and risk of hepatocellular carcinoma (HCC)in individuals with morbid obesity in a large, registry-based cohort. Background: Obesity is a significant risk factor for HCC. MBS has been shown to reduce obesity-related comorbidities and improve liver health, but its effect on HCC risk remains unclear. Methods: This retrospective observational study used data from the French National Healthcare Database (SNDS) from 2013 to 2023. Adults with obesity were categorized into two groups: individuals with a history of MBS (MBS group) and those without (control group). Patients with active cancer, liver cirrhosis, viral hepatitis, or HCC at baseline were excluded. Subgroup analyses were performed based on obesity severity and the type of MBS procedure. Results: Among 2 163 083 eligible patients, 212 315 underwent MBS. Over a median follow-up of 5.1 years, HCC incidence was significantly lower in the MBS group (0.027 per 1000 PYFU) compared with controls (0.353 per 1000 PYFU). MBS was associated with a 74% reduction in HCC risk (HR = 0.265, 95% CI = 0.184–0.382, P < 0.0001). Findings were consistent after propensity score matching and competing risk analysis (HR = 0.305, 95% CI = 0.198–0.471, P < 0.0001). The protective effect of MBS was observed for both sleeve gastrectomy and Roux-en-Y gastric bypass. Conclusion: MBS significantly reduces the risk of HCC in individuals with morbid obesity.