减肥手术可降低肥胖相关癌症和心血管疾病的风险，但通常只针对 60 岁以下的患者。这些关联对于年龄较大时接受手术的患者是否成立尚不确定。为了确定减肥手术是否与 60 岁或以上接受手术的患者患肥胖相关癌症和心血管疾病的风险降低有关。基于人群的队列这项研究的对象是 1989 年至 2019 年间来自丹麦、芬兰和瑞典的 60 岁或以上接受减肥手术且既往无恶性肿瘤或心血管疾病的患者。每位接受手术的患者与该地区 5 名接受非手术治疗的肥胖患者完全匹配。手术当天的国家、性别和年龄相同。数据于2023年12月进行分析。接受肥胖治疗，包括减肥手术和非手术治疗。主要结局是肥胖相关癌症，定义为乳腺癌、子宫内膜癌、食管癌、结直肠癌和肾癌的综合结局，从国家癌症数据库中确定癌症登记处。次要结局是心血管疾病，定义为从患者登记中确定的心肌梗塞、缺血性中风和脑出血的复合结局。多变量 Cox 回归提供了针对糖尿病、高血压、周围血管疾病、慢性阻塞性肺疾病、肾脏疾病和虚弱进行调整后的 95% CI 的风险比 (HR)。总共 15300 名患者（中位 [IQR] 年龄，63 [61] -65]岁；10152名女性患者[66.4%]）被纳入其中，其中2550名（16.7%）在60岁或以上接受了减肥手术，12750名（83.3%）接受了非手术治疗。在中位 (IQR) 为 5.8 (2.8-8.5) 人年的随访期间，658 人 (4.3%) 患上肥胖相关癌症，1436 人 (9.4%) 患心血管疾病。接受手术和未接受手术的患者患肥胖相关癌症（HR，0.81；95% CI，0.64-1.03）和心血管疾病（HR，0.86；95% CI，0.74-1.01）的风险相似。胃绕道手术（1930 名患者）与肥胖相关癌症（71 名患者[3.7%]；HR，0.74；95% CI，0.56-0.97）和心血管疾病（159 名患者[8.2%]；HR， 0.82；95% CI，0.69-0.99）与匹配对照（9650 名患者；肥胖相关癌症：442 名患者 [4.6%]；心血管疾病：859 名患者 [8.9%]）相比。患者与肥胖相关癌症和心血管事件的较低发生率无关，但有证据表明胃绕道手术可能与这两种结果的风险较低有关。

Bariatric surgery is associated with decreased risk of obesity-related cancer and cardiovascular disease but is typically reserved for patients younger than 60 years. Whether these associations hold for patients who undergo surgery at older ages is uncertain.To determine whether bariatric surgery is associated with a decreased risk of obesity-related cancer and cardiovascular disease in patients who underwent surgery at age 60 years or older.Population-based cohort study of patients from Denmark, Finland, and Sweden who underwent bariatric surgery at age 60 years or older without previous malignant neoplasm or cardiovascular disease between 1989 and 2019. Each patient who underwent surgery was exactly matched to 5 patients with nonoperative treatment for obesity of the same country, sex, and age at the date of surgery. Data were analyzed in December 2023.Receiving treatment for obesity, including bariatric surgery and nonoperative treatments.The main outcome was obesity-related cancer, defined as a composite outcome of breast, endometrial, esophageal, colorectal, and kidney cancer, identified from the national cancer registries. The secondary outcome was cardiovascular disease, defined as a composite outcome of myocardial infarction, ischemic stroke, and cerebral hemorrhage, identified from the patient registries. Multivariable Cox regression provided hazard ratios (HR) with 95% CIs adjusted for diabetes, hypertension, peripheral vascular disease, chronic obstructive pulmonary disease, kidney disease, and frailty.In total, 15 300 patients (median [IQR] age, 63 [61-65] years; 10 152 female patients [66.4%]) were included, of which 2550 (16.7%) had bariatric surgery at age 60 or older and 12 750 (83.3%) had nonoperative treatment. During a median (IQR) of 5.8 (2.8-8.5) person-years of follow-up, 658 (4.3%) developed obesity-related cancer and 1436 (9.4%) developed cardiovascular disease. The risk of obesity-related cancer (HR, 0.81; 95% CI, 0.64-1.03) and cardiovascular disease (HR, 0.86; 95% CI, 0.74-1.01) were similar among who underwent surgery and those who did not. Gastric bypass (1930 patients) was associated with a decreased risk of obesity-related cancer (71 patients [3.7%]; HR, 0.74; 95% CI, 0.56-0.97) and cardiovascular disease (159 patients [8.2%]; HR, 0.82; 95% CI, 0.69-0.99) compared with matched controls (9650 patients; obesity-related cancer: 442 patients [4.6%]; cardiovascular disease: 859 patients [8.9%]).This cohort study found that bariatric surgery in older patients is not associated with lower rates of obesity-related cancer and cardiovascular events, but there was evidence that gastric bypass may be associated with lower risk of both outcomes.