Should Bariatric Surgery Candidates Be Screened for Colorectal Cancer? A Systematic Review

Introduction: Obesity and colorectal cancer risk relationship is well-documented and bariatric surgery has become one of the most common surgical operations for losing weight. There is no guideline suggestion for the candidates of bariatric surgery for routine screening of colorectal cancer. The aim of this systematic review is to evaluate the place and necessity of screening colonoscopy before weight loss surgery under the light of published articles. Methods: A systematic literature review was conducted in accordance with PRISMA guidelines using electronic databases of PubMed and Google Scholar. The protocol was registered in the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY; registration number: INPLASY202630078). No restrictions were applied regarding the publication dates of the articles. We performed the PRISMA guidelines for systematic review and the PICOS framework was employed. Results: A total of 623 patients, 365 women and 258 men, underwent routine colonoscopy before bariatric surgery in three cohort studies. The average age and body mass index of the patients were 47.4 ± 10.4 (range 14-87) and 43.7 ± 7.1 kg/m², respectively. A total of 57 (9.1%) histologically confirmed pathologies were found during colonoscopy, 51 adenomatous polyps (8.1%) and six (1.0%) colorectal cancers. Five of the six CRC patients (83%) were over 45 years of age and three (50%) of them were over 60 years of age. Conclusions: The decision to screen bariatric surgery candidates for colorectal cancer should be individualized, based on age (≥45 years), family history, symptomatology, and comorbidities (inflammatory bowel disease). Bariatric surgeons should strongly consider colorectal cancer screening as part of preoperative workup in eligible patients.