Metabolic Surgery Progenitor of Effective Therapy for Atherosclerotic Cardiovascular Disease, Cancer, Type 2 Diabetes, and Obesity

"Metabolic Surgery Progenitor of Effective Therapy for Atherosclerotic Cardiovascular Disease, Cancer, Type 2 Diabetes, and Obesity"  

Peer-reviewed by Reza Lankarani  

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Ann Surg Volume 281, Number 5, May 2025

DOI: 10.1097/SLA.0000000000006588

Annals of Surgery

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Henry Buchwald's article, "Metabolic Surgery: Progenitor of Effective Therapy for Atherosclerotic Cardiovascular Disease, Cancer, Type 2 Diabetes, and Obesity," published in the Annals of Surgery (Volume 281, Number 5, May 2025), offers a comprehensive exploration of metabolic surgery’s role as a pioneering force in modern medicine. Buchwald defines metabolic surgery as the operative manipulation of normal organs to achieve beneficial metabolic outcomes, a concept formalized in 1978 but with roots tracing back to 1889 with oophorectomy for breast cancer. The article focuses on four key conditions—atherosclerotic cardiovascular disease (ASCVD), cancer, type 2 diabetes, and obesity—demonstrating how surgical interventions have elucidated metabolic pathways, paving the way for nonsurgical therapies. For ASCVD, the Program on the Surgical Control of the Hyperlipidemias (POSCH) trial showcased partial ileal bypass reducing cholesterol and mortality, influencing statin development. In cancer, oophorectomy’s hormonal insights prefigured drugs like tamoxifen. 

For type 2 diabetes and obesity, bariatric surgery’s metabolic effects, particularly via GLP-1 elevation, inspired drugs like Ozempic and Wegovy. Buchwald lists 22 procedures and suggests future applications (e.g., traumatic brain injury), arguing that metabolic surgery transforms surgery into a metabolic discipline driving translational research cyclically.

By Reza Lankarani M.D