SOBRACIL

Newsletter Sobracil-SP vol 3; 2007

Lars Sjöström, M.D., Ph.D., Kristina Narbro, Ph.D., C. David Sjöström, M.D., Ph.D., Kristjan Karason, M.D., Ph.D., Bo Larsson, M.D., Ph.D., Hans Wedel, Ph.D., Ted Lystig, Ph.D., Marianne Sullivan, Ph.D., Claude Bouchard, Ph.D., Björn Carlsson, M.D., Ph.D., Calle Bengtsson, M.D., Ph.D., Sven Dahlgren, M.D., Ph.D., Anders Gummesson, M.D., Peter Jacobson, M.D., Ph.D., Jan Karlsson, Ph.D., Anna-Karin Lindroos, Ph.D., Hans Lönroth, M.D., Ph.D., Ingmar Näslund, M.D., Ph.D., Torsten Olbers, M.D., Ph.D., Kaj Stenlöf, M.D., Ph.D., Jarl Torgerson, M.D., Ph.D., Göran Ågren, M.D., and Lena M.S. Carlsson, M.D., Ph.D., for the Swedish Obese Subjects Study

Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects
N Engl J Med 2007 357 (8): 741-52. lars.sjostrom@medfak.gu.se

BACKGROUND: Obesity is associated with increased mortality. Weight loss improves cardiovascular risk factors, but no prospective interventional studies have reported whether weight loss decreases overall mortality. In fact, many observational studies suggest that weight reduction is associated with increased mortality. METHODS: The prospective, controlled Swedish Obese Subjects study involved 4047 obese subjects. Of these subjects, 2010 underwent bariatric surgery (surgery group) and 2037 received conventional treatment (matched control group). We report on overall mortality during an average of 10.9 years of follow-up. At the time of the analysis (November 1, 2005), vital status was known for all but three subjects (follow-up rate, 99.9%). RESULTS: The average weight change in control subjects was less than ±2% during the period of up to 15 years during which weights were recorded. Maximum weight losses in the surgical subgroups were observed after 1 to 2 years: gastric bypass, 32%; verticalbanded gastroplasty, 25%; and banding, 20%. After 10 years, the weight losses from baseline were stabilized at 25%, 16%, and 14%, respectively. There were 129 deaths in the control group and 101 deaths in the surgery group. The unadjustedoverall hazard ratio was 0.76 in the surgery group (P = 0.04), as compared with the control group, and the hazard ratio adjusted for sex, age, and risk factors was 0.71 (P = 0.01). The most common causes of death were myocardial infarction (control group, 25 subjects; surgery group, 13 subjects) and cancer (control group, 47; surgery group, 29). CONCLUSIONS: Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality.

Comentários: O estudo publicado pelo grupo sueco coordenado pelo Dr. Lars Sjöström, através deste artigo, é uma continuação do único prospectivo não randomizado publicado na literatura. Agora com 15 anos de seguimento de obesos mórbidos. Diversas variáveis foram avaliadas, comparando acompanhamento clínico multidisciplinar com gastroplastia vertical (Mason), banda gástrica ajustável e derivação gastrojejunal em “Y-de-Roux”.

Neste estudo em particular, os autores procuraram relacionar objetivamente, a perda ponderal com redução de mortalidade em longo prazo e apresentaram seus resultados em gráficos de fácil compreensão, concluindo que o fato de submeter um obeso mórbido a qualquer um dos procedimentos cirúrgicos estudados, foi o grande fator de redução da mortalidade, reafirmando os achados do estudo anteriormente publicado com dez anos de acompanhamento. Acrescentaram ainda, que este aumento na sobrevida é mais significativo em idades mais avançados, devido a melhor controle do diabetes melitus, diminuição dos riscos cardiovasculares, da apnéia do sono, das dores articulares e ganho na qualidade de vida.

Albino A. Sorbello
Guilherme T. Kappaz – R3 Gastro Cirurgia HSPE
Mauricio Sorbello – R2 Cirurgia Geral HC-FMUSP